Between 1979 and 1996, the annual percentage of men diagnosed with prostate cancer in earlier stages (in situ and localized stages) increased from 56 percent to 67 percent (see Figure 7 and Appendix II, Table 7). The percent of men reported as diagnosed at the distant stage of prostate cancer, for which survival is much lower, showed a sharp decline from a high of over 22 percent in 1985 to less than 5 percent in 1996. (Note that in contrast to other parts of this Report, this section includes prostate cancer cases diagnosed in the in situ as well as in the invasive stages. The proportion of in situ cases was below 1% each year).
The decreasing proportion of cancers of unknown stage in the data collected during the first years of the NJSCR indicate improving data quality during subsequent years for cancers of all types, including prostate. During the most recent years shown, there has been a slightly rising proportion of unknown stage at diagnosis, which may be related to the ability to diagnose and manage many prostate cancers without the surgical procedures that provide definitive staging information for prostate cancer. Stage at diagnosis is sometimes not reported because it can not be determined definitively without surgery, and surgery is not always the treatment of choice for prostate cancer. In the early 1990s, the increased proportion of unknown stage at the time of initial diagnosis was also probably related to increased use of PSA and confirmatory needle biopsy which does not, by itself, distinguish between local and regional stage of prostate cancer. (The years 1979-1983 are not shown in Figures 8 and 9 because the percentage of cases diagnosed at the unknown stage were high those years.)
Stage at Diagnosis by Race: 1984-1996
During the years 1984 to 1996 the percent of prostate cancer cases diagnosed in the in situ or localized stage increased greatly for both white and black men, but black men continued to have a higher percentage of their prostate cancer diagnosed at the distant stage than did white men (see Figures 8 and 9 and Appendix II, Tables 8 and 9). In 1996, about 68 percent of both white and black men were diagnosed at an early stage, i.e. localized or in situ.
(Note: The difference between the 100 percent and the end of each stack bar is the percent of cases with an unknown diagnosis.)
Stage at Diagnosis by County: 1979-1996
The percentage of prostate cancer cases diagnosed in the early stages (in situ and localized) in 1979-1996 also varied by county of residence (see Table 2 below). The counties which had the lowest proportions (less than 10%) of prostate cancers diagnosed at the distant stage were Bergen, Hunterdon, Middlesex, Monmouth, Morris, Ocean, and Somerset. The counties with the highest proportion diagnosed at the distant stage (greater than 13%) were Atlantic, Camden, Cumberland, Essex, and Hudson. As noted above, survival of prostate cancer is dramatically enhanced when the disease is diagnosed prior to its metastases to parts of the body distant from the prostate. It is unknown at this time whether there is a systematic reason for the particular geographic variations noted above or whether they are the result of random fluctuation.
Prostate Cancer Stage At Diagnosis
By County, New Jersey - 1979-1996*
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