Background and Risk Factors

The prostate gland is located at the base of the penis, surrounds the urethra, and produces seminal fluid. The causes of prostate cancer are mostly unknown. Family history of prostate cancer in a first-degree relative (father, brother) appears to double the risk of prostate cancer. A history of some benign prostatic diseases such as prostatitis and some types of hyperplasias also may increase the risk. Male sex hormones such as testosterone may be related to prostate cancer. Various epidemiologic studies suggest that a diet high in animal fat leads to an increased risk of prostate cancer, perhaps through influencing hormone levels.

A sexually-transmitted agent is suspected of causing some cases of prostate cancer because sexual activity and sexually-transmitted diseases are more frequent among men with prostate cancer than men without prostate cancer. Certain occupational exposures also are suspected of causing prostate cancer: work with cadmium, farming, rubber manufacturing, and work in iron and steel foundries.

Prevention and Control

It is difficult to prevent prostate cancer because the causes are not well understood. The American Cancer Society recommends that every man 50 or older have a prostate- specific antigen (PSA) blood test and digital rectal examination as part of his annual physical checkup. (See Appendix I. )

Incidence and Mortality in the U.S.

Prostate cancer is the most common cancer among men; 184,500 new cases are estimated for 1998 in the U.S. Prostate cancer incidence rates have increased greatly since the late 1940s due partly to increased diagnosis in the asymptomatic or early stage. The incidence of prostate cancer is much higher in black men than white men and increases with age. Over 80 percent of all prostate cancers are diagnosed in men over age 65. The five-year survival rate is 89 percent; if diagnosed in the early stages, the five-year survival rate is 100 percent. With an estimated 39,200 deaths in 1998 in the U.S., prostate cancer is the second leading cause of cancer death among men. Prostate cancer mortality rates have also increased over the years. Black men have more than twice the prostate mortality rate as white men.

Incidence in New Jersey - 1986-1996

Tables 44 through 46 contain the incidence data by county for prostate cancer for the years 1986 through 1996. Figure 15 shows statewide trends; black males had higher rates than white males and the difference in rates appears to have increased since 1992. Black males had higher rates than white males in each county (see Table 44). The rates increased greatly between 1986 and 1992 for white males and between 1986 and 1993 for black males. After that the rates declined (see Figure 15). This time trend is probably due to the widespread introduction during these years of screening methods which detect prostate cancer earlier.

Conclusion

Continued research on the causes of prostate cancer is needed since the causes are not well understood. The recommendations regarding screening should be followed in order to detect it early.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	60	57.6	65	61.2	79	74.6	94	87.5	107	100.0	143	128.2	210	187.8	216	197.4	162	145.7	183	166.4	140	125.0
Bergen	347	76.3	430	94.6	425	92.2	432	92.5	538	113.4	754	156.2	941	193.0	777	159.1	718	147.6	691	142.2	667	138.3
Burlington	96	70.1	118	82.3	132	90.8	152	100.4	169	106.3	207	131.9	306	191.2	290	180.8	237	146.5	222	134.8	172	104.0
Camden	145	75.1	120	59.6	177	87.2	154	77.9	178	86.8	243	113.9	324	151.1	254	121.6	218	104.8	225	107.8	222	109.0
Cape May	65	97.5	68	98.4	74	106.9	93	127.4	96	132.5	132	180.7	148	195.1	144	197.6	124	169.1	133	178.7	115	152.9
Cumberland	35	56.4	46	74.3	48	75.2	45	70.5	57	86.9	84	127.6	95	148.1	105	164.9	69	109.7	59	93.0	85	136.0
Essex	204	71.3	249	87.4	254	90.5	253	91.5	308	114.3	420	155.7	560	210.8	443	168.7	418	163.5	344	135.7	364	149.5
Gloucester	57	75.1	60	78.1	57	70.9	48	56.8	76	84.3	95	101.2	133	144.2	127	134.1	119	124.7	111	112.7	81	83.8
Hudson	177	72.9	179	74.8	184	77.9	161	68.7	186	79.8	245	102.9	273	115.8	269	113.6	257	108.9	247	105.6	245	104.9
Hunterdon	32	81.4	28	70.3	29	72.6	42	99.7	38	86.2	41	92.9	60	130.1	77	160.5	54	112.3	39	78.9	46	92.1
Mercer	134	101.7	140	105.1	142	102.9	148	106.3	193	137.7	213	149.4	266	186.2	247	175.4	223	154.8	220	156.8	207	145.1
Middlesex	227	87.0	207	77.9	230	84.3	208	74.2	295	103.3	400	134.5	503	164.9	451	146.2	374	122.0	419	135.7	365	117.9
Monmouth	199	81.9	169	68.6	208	83.6	211	83.9	241	95.7	360	139.0	472	179.2	467	175.9	368	138.7	341	127.8	352	131.5
Morris	130	80.5	147	87.5	139	81.1	167	97.6	194	110.0	275	154.1	375	206.5	374	202.5	286	152.3	302	158.4	303	156.0
Ocean	279	81.0	290	80.4	293	80.4	300	78.0	350	92.1	560	142.8	774	194.5	655	168.9	568	148.0	494	128.5	330	88.0
Passaic	159	76.1	192	92.6	187	90.7	198	96.8	217	106.6	304	145.6	365	176.9	292	141.0	288	139.0	276	135.2	275	137.1
Salem	23	76.5	21	67.7	22	67.5	27	81.3	33	101.8	56	166.4	36	109.7	54	154.5	49	151.6	35	104.6	27	81.0
Somerset	57	62.3	64	67.5	73	76.0	86	87.0	88	87.4	121	114.3	190	172.2	140	124.6	137	120.7	142	121.8	154	130.4
Sussex	26	58.5	46	102.6	42	92.9	38	82.6	56	121.3	58	120.0	83	171.5	90	179.3	68	134.4	71	138.7	71	135.2
Union	214	84.4	205	80.7	230	90.5	261	102.6	296	117.2	424	162.6	558	216.0	374	146.5	293	117.3	301	119.9	335	136.2
Warren	46	106.4	38	86.0	55	126.3	40	88.7	42	91.5	61	131.3	102	209.9	90	186.6	61	127.2	92	187.0	64	125.4
STATE	2713	78.3	2882	82.0	3082	86.7	3162	88.0	3770	103.6	5221	140.7	6777	181.3	5939	158.8	5095	136.6	4962	132.7	4624	124.1

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	20	128.1	19	122.6	25	162.1	21	131.5	9	59.4	17	104.1	38	220.0	41	230.7	27	148.6	54	285.2	47	252.5
Bergen	19	148.3	19	141.0	18	130.1	17	118.0	24	171.0	27	188.5	29	184.6	33	210.0	30	179.0	43	243.9	39	210.9
Burlington	14	107.5	16	124.8	24	189.8	19	134.7	29	176.2	40	267.4	46	313.9	49	265.7	59	344.6	54	271.1	43	188.4
Camden	28	129.1	23	100.8	37	158.6	25	101.9	27	110.2	46	179.7	66	248.3	59	213.7	52	184.8	66	220.6	40	127.6
Cumberland	10	170.7	---	---	6	91.9	7	115.7	9	140.5	11	186.6	5	76.4	21	306.3	10	151.3	11	144.0	13	174.2
Essex	117	138.1	109	120.3	146	162.7	133	141.3	169	185.8	182	196.2	225	237.0	233	234.5	218	221.3	246	238.4	228	216.7
Gloucester	7	91.0	14	181.8	7	78.6	5	64.2	12	140.7	10	106.0	22	229.9	25	254.3	19	196.4	15	137.7	15	139.5
Hudson	21	112.9	19	109.6	21	115.8	21	108.2	27	142.6	37	191.2	39	194.3	44	230.6	37	182.1	43	192.8	52	226.5
Mercer	24	130.4	22	121.8	22	113.6	21	102.6	43	220.1	36	174.5	56	258.5	69	315.9	61	269.2	73	303.7	66	264.9
Middlesex	10	95.2	15	155.3	16	158.8	20	156.9	13	104.5	14	106.0	37	281.5	38	255.3	35	246.5	24	142.2	20	124.2
Monmouth	9	55.7	21	121.9	18	108.9	15	87.4	20	118.7	28	151.8	37	186.0	43	212.4	31	149.2	49	221.6	37	162.5
Morris	---	---	---	---	7	212.4	---	---	---	---	7	191.7	8	214.4	15	389.2	15	446.5	8	202.3	8	168.5
Ocean	---	---	---	---	--	---	8	257.6	5	193.5	7	220.8	11	287.3	9	251.5	10	251.3	---	---	---	---
Passaic	16	91.8	17	152.0	22	149.9	11	65.6	19	110.3	21	126.9	25	137.5	29	166.1	34	182.6	29	159.3	36	176.6
Salem	7	165.3	---	---	7	163.9	7	160.7	5	112.5	7	149.1	9	189.6	13	249.5	8	156.0	9	177.3	14	248.5
Somerset	---	---	---	---	---	---	---	---	---	---	7	181.2	11	326.0	10	191.6	11	227.4	8	154.1	7	128.5
Union	27	117.9	31	123.1	37	140.6	44	163.0	39	145.6	50	176.2	76	258.7	82	278.0	73	236.9	86	252.0	72	209.6
STATE	338	121.7	346	121.3	420	143.3	386	126.4	463	152.0	554	175.7	745	228.1	828	244.3	741	213.9	830	224.9	749	196.8

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Cape May, Hunterdon, Sussex, and Warren counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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