The State of Our Health - Men's Health: Prostate Cancer

Prostate cancer is the second leading cause of deaths of men by cancer (after lung cancer). It is the leading cause of cancer death among men 75 years or older. The graphic shows age-adjusted death rates per 100,000 population. In 1999, one year beyond the time frame of the graphic, there were 179,300 cases of prostate cancer and 31,728 men died of the disease.

Roughly midway through the period shown, a new prostate cancer screening method was approved by the FDA. This method, commonly known as the PSA blood test ("prostate specific antigen"), may in part explain both the spike in the death rate and its decline. The logic is laid out by the National Institutes of Health in a News Advisory (see source note). The essence, in summary, is as follows:

Prostate cancer mortality rates have been increasing gradually since 1977, sped up in the mid-1980s, and began to drop slightly in 1992 for white males, in 1994 for black males. The PSA test was approved in 1986, but did not come into wide use until after 1989, when new diagnoses of preclinical prostate cancer shot up. (Clinical diagnoses actually detect the formation of a tumor.) The test added a five-year lead-time to the detection of prostate cancer and may be producing a decline in mortality rates late in this period. However, the blood test may also have produced the spurt in mortality due to what the NIH labels "attribution bias." To quote:

Attribution bias is "a distortion of true mortality rates that occurs when the stated cause of the death is incorrect. A recently diagnosed cancer may be recorded as cause of death, even if, as in the case of preclinical prostate cancers, it is almost certainly not the true cause of death. The death of an elderly man might thus be wrongly attributed to prostate cancer simply because a recent diagnosis is in his files and no other underlying cause could be identified."

The cause of the cancer is not known, although an interesting correlation has been observed. Testosterone levels increase with the intake of dietary fat. At the same time, lowering testosterone levels — by surgical removal of testicles or medication — can cause prostate cancer to regress. At this time the medical community is not willing to go further than simply stating these relationships. A lay person might observe, however, that we are becoming more obese — and that prostate cancer is encountered least among fish-eating Japanese men and vegetarians.

The higher mortality rate of black men, and the lag-time in the down-turn of the mortality rate of blacks, again shows that the African American community is not receiving the same health care — for whatever reasons — than the wider community.

Death rates from prostate cancer increase with age and are highest among those 85 years old and older. Longevity may have its downside.

Source: Centers for Disease Control and Prevention. National Center for Health Statistics. National Vital Statistics System. Online. Available: http://www.cdc.gov/nchs/default.htm. May 29, 2002. Background information: MEDLINEplus. Online. Available: http://www.nlm.nih.gov/medlineplus/ency/article/001566.htm. Information from the NIH is taken from: "Recent Trends in Prostate Cancer Incidence and Mortality." Press Release. 21 November 1997. National Institutes of Health. National Cancer Institute.