Cancer of the prostate was the most frequent cancer diagnosed among men in the SRRHIS region from 1991 through 1993. During this time 2,051 cases were diagnosed, 1,213 among white men and 768 among blacks. The incidence rate for white males was much lower than the rate for comparison populations (SRRHIS: 113.3; Atlanta: 182.2; SEER: 161.1) (Figure 23) but similar in the Savannah, Augusta and rural areas. The rate for black males was also lower than for comparison groups (SRRHIS: 181.9; Atlanta: 228.6; SEER: 215.1). Although the incidence rate appears higher in the South Carolina counties, closer examination shows this to be a result of the rural black males having higher rates than those living in the Augusta or Savannah areas (rural black males 205.5 per 100,000; Augusta and Savannah, 157.6, not shown).

Sixty-three prostate cancer cases (3.1%) were reported with race unknown. These were generally from pathology reports without hospital admissions. Knowing the race of the cases would increase the usefulness of the data evaluation in understanding patterns of prostate cancer in the SRRHIS population. In the remarkably low incidence rates for white males, 30 percent lower than national rates suggests that screening for early disease may be less common in the SRRHIS areas.

Because of the availability of new screening technologies the frequency of diagnosing prostate cancer early, often before it becomes clinically apparent, is increasing. As a result, the incidence rates have been increasing dramatically, nationally. In the SRRHIS population 61 percent of cases in white males and 50 percent in black males were localized at diagnosis. Black men were diagnosed with distant disease in 19 percent of cases compared to 6 percent among white men (Figure 24). The high incidence rate for rural black males and the higher frequency of advanced disease at diagnosis should be investigated further to determine the benefit of targeting rural black populations for early detection programs.

Five year relative survival rates for prostate cancer are 86 percent for all stages, but 99 percent for men diagnosed with localized disease, falling to 30 percent for men with distant metastases at diagnosis (Kosary, 95).

Other than aging and race, risk factors for prostate cancer are not well understood. Black men have the highest incidence and mortality, while Asian men rarely are diagnosed with prostate cancer. Persons with a family history of prostate cancer are at higher risk, so genetic factors may be involved. Diets high in animal fats have been associated with increased risk. Other factors that may be associated with increased risk include a history of venereal disease and multiple sexual partners (Miller, 93).

Given current incidence rates and longevity, about one in five men will be diagnosed with prostate cancer. While current screening technology makes early detection more easily available, treatment options for early stage disease remain somewhat controversial.