Prostate cancer incidence, mortality, stage at diagnosis, and treatment patterns among white and African American men in North Carolina

Statistical Brief No. 48 August 2017 1908 Mail Service Center ♦ Raleigh, NC 27699-1900 919.733.4728 ♦ www.schs.state.nc.us Prostate Cancer Incidence, Mortality, Stage at Diagnosis, and Treatment Patterns among White and African American Men in North Carolina Sohrab АН, MPH, MIS, MA, Statistician, North Carolina Central Cancer Registry Soundarya Radhakrishnan, MS, Statistical Supervisor, North Carolina Central Cancer Registry Introduction Prostate cancer is the most frequently diagnosed cancer among men in North Carolina. In 2014, 6,197 men were diagnosed with and 900 died from prostate cancer. The North Carolina Central Cancer Registry estimates that in 2017, about 7,577 new cases of prostate cancer will be diagnosed and 990 men will die of prostate cancer in North Carolina.1 African American men have greater prostate cancer incidence and greater mortality than white men.1 In 2014, the age-adjusted prostate cancer incidence rate for African American men was 167.9 and incidence rate for white men was 91 .7. The death rate for African American men was 37.7 and the death rate for white men was 1 7.6. In 2013, the age- adjusted national (U.S.) prostate cancer incidence rate for African American men was 164.4 (per 100,000) and the incidence rate for white men was 92.6 (per 100,000).2 The death rate for African American men was 39. 1 (per 100,000) and the death rate for white men was 18.0. (per 100,000).-' Early detection can help in identifying treatment options. Methods Data Sources The most current data on prostate cancer incidence were obtained through the North Carolina Central Cancer Registry (N.C. CCR). Data on prostate cancer deaths were obtained from the Vital Statistics Unit of the State Center for Health Statistics (SCHS). Population data from the National Center for Health Statistics (NCHS) were used in the denominators of the rates, which are expressed per 100,000 population. Five-year (2010-2014) incidence and mortality rates for white men and African American men were calculated to assess racial disparities in prostate cancer. Rates were age-adjusted to the 2000 United States standard population. Localized, regional, distant and unknown categories were used for defining the cancer stage. The analysis for treatment was performed for the five-year period of 2010-2014. Information about prostate cancer treatment is categorized into surgery, chemotherapy, hormone therapy and radiation therapy. For comparison, 2013 national age-adjusted incidence2 and mortality' rates of prostate cancer were obtained from the CDC Wonder website. Results Incidence and Mortality Rates In 2010-2014 there were 22,783 prostate cancer cases reported for white men and 8,576 reported for African American men. Incidence and death rates by race (2010-2014) are presented in Table 1 . The five-year, age-adjusted prostate cancer death rate Table 1. 2010-2014 Prostate Cancer Incidence and Mortality Rates per 100,000 Population for White and African American Men in North Carolina Incidence Mortality Race Cases Rate* Cases Rate* White 22,783 107.9 2,965 17.8 African American 8,576 189.5 1.306 44.3 *Ratcs arc age Adjusted and expressed per 1 00,000 population The widespread use of prostate-specific antigen (PSA) testing has dramatically changed the epidemiology of prostate cancer. According to the American Cancer Society, incidence rates for prostate cancer spiked dramatically in the United States in the late 1980s and early 1990s, in large part because of increased use of the PSA blood test for screening. Since then, rates have been steadily declining. From 2007 to 201 1, incidence rates were stable in men younger than 65 and decreased by 2.8 percent per year in those 65 and older.1 SPUR has reported similar findings. Using statistical models for analysis, rates for new prostate cancer cases have been falling on average 2.4 percent each year over the last 1 0 years.2 The decline in rates may represent the effect of screening anticipation: incidence has become lower than expected as cases that were bound to present have already been diagnosed through screening. The decline in the incidence rate observed in North Carolina is consistent with that found in the national statistics and may suggest that the PSA screening prevalence effect is starting to subside. For more information on the PSA Test, see www.canccr.gov/canccrtopics/factshcct/dctcction/PSA. 'American Cancer Society, Cancer Facts & Figures, 2015. Atlanta: American Cancer Society; 2015. 2http://sccr.canccr.gov/statistics''summaries.html (accessed 1/26/2015).