Context

Prostate cancer is a common cancer worldwide, with incidence and mortality varying significantly across ethnic groups.1 2 Black men are at a higher risk of prostate cancer diagnosis and death, while Asian men are at a lower risk compared with white men.3 4 Despite these disparities, there is no formal prostate cancer screening programme in the UK, though prostate-specific antigen (PSA) tests are available on request. Understanding these risks is critical for guiding clinical decision-making and ensuring equitable healthcare outcomes in the UK.

Findings

The study found that black men had the highest prostate cancer incidence (24.7%) within 1 year of a raised PSA result, while Asian men had the lowest (13.4%). White men had an incidence of 19.8%. The risk of advanced prostate cancer was similar for black and white men but lower for Asian men. These findings highlight a significant ethnic disparity in prostate cancer diagnosis in the UK, with black men at higher risk even after adjusting for demographic factors.

Commentary

Down et al shed light on important ethnic differences in prostate cancer risk following PSA tests.5 The finding that black men have a significantly higher incidence compared with other ethnic groups aligns with US research.4 However, this study adds valuable insight into the UK population, where healthcare access is more equitable through the National Health Service. Despite this, ethnic disparities persist, suggesting that factors beyond healthcare access, such as genetic predispositions, cultural differences in healthcare-seeking behaviour and PSA-level variations, may contribute.

One strength of this study is its large sample size (n=730 515), which makes the findings robust and representative of the UK population. However, the study has limitations, including the inability to fully capture the reasons for PSA testing, which introduces bias. For instance, black men at higher risk may be more likely to request or be offered PSA tests. The study also did not account for a family history of prostate cancer, a known risk factor.

Interestingly, black men did not have higher rates of advanced prostate cancer despite their higher incidence. This challenges the assumption that black men are more likely to present with more aggressive cancer and may suggest that increased awareness and earlier testing among black men in the UK could contribute to earlier diagnosis.6

In conclusion, this study underscores the importance of considering ethnicity when interpreting PSA results and highlights the need for further research to explore the underlying causes of disparities. Future studies should investigate the role of genetic and environmental factors and consider the development of tailored screening guidelines for high-risk ethnic groups.