Mortality from prostate cancer has gradually increased among both Caucasians and African Americans during the past two decades. In absolute terms, 33,565 men died of prostate cancer in 1991 and 34,901 men in 1994.5 When viewed in relative terms, however, the data suggest a different trend. Among Caucasian men, the age-adjusted mortality rate rose from 20.3 deaths per 100,000 men in 1973 to 24.7 deaths per 100,000 men in 1991. Rates among African Americans were more than twice as high. Since then the rates have declined. The National Cancer Institute recently reported data showing that the prostate cancer death rate in the United States fell between 1991 and 1995, from 26.5 to 17.3 deaths per 100,000 men in the overall population.7 The percentage decline was greatest for young Caucasion males and smallest for older men and African American men (Figure 1-4). The differences between absolute and relative age-adjusted rates are explained by the increasing number of men dying from prostate cancer but the even greater increase in the number of older men still alive in the United States population. The increase in the size of the population at risk (the denominator) has been proportionally more rapid than the increase in the number of men dying from prostate cancer (the numerator). This has resulted in a recent small age-adjusted decline during the past year.
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