Ethnicity and prostate cancer: the answer to the screening dilemma?

Recent results published in BMC Medicine provide insights into prostate cancer risk for men of different ethnicities. Here, we explore the implications of these findings for prostate cancer screening, and take a look at the public response to the research.

At the end of last week, BMC Medicine published the results of a study by authors from Prostate Cancer UK showing that Black men are twice as likely to be diagnosed with, and die from, prostate cancer compared with White men.

The authors analyzed incidence and mortality data from Public Health England, and found that the lifetime risk of being diagnosed with prostate cancer is approximately 1 in 4 for Black men, 1 in 8 for White men, and 1 in 13 for Asian men. While some data on ethnicity was missing, meaning that assumptions were made in the analysis, these results provide important information to help men understand their individual prostate cancer risk. Lead author Alison Cooper from Prostate Cancer UK said:

These figures can be used for targeted awareness-raising and to help them make an informed decision about whether or not to have a PSA test


Alison Cooper

[The study] provides important absolute-risk figures to help black men better understand their risk of developing prostate cancer. These figures can be used for targeted awareness-raising and to help them make an informed decision about whether or not to have a prostate-specific antigen (PSA) test.

Can the results guide PSA testing?

In a commentary published today in BMC Medicine, Leonard Bokhorst and Monique Roobol from Erasmus MC discuss the research, highlighting that the information provided is easy to understand and helpful for men to decide whether to undergo PSA testing. However, Bokhorst and Roobol caution that stratifying prostate cancer risk by ethnicity will not solve the PSA testing dilemma. They explain that even if prostate cancer risk is higher in some ethnic groups, the possible benefits of screening should still be weighed up against the risk of over-diagnosis, which does not differ between ethnic groups. Bokhorst and Roobol conclude that:

a higher than average risk of prostate cancer death for some groups should still be
weighed against the harms of over diagnosis and related overtreatment


Bokhorst and Roobol

Lifetime risks of prostate cancer diagnosis and prostate cancer death specified by race provides patients with useful information on their personal condition and can help in deciding whether to start PSA testing. However, a higher than average risk of prostate cancer death for some groups should still be weighed against the harms of over diagnosis and related overtreatment

Responses to the study

Cooper and colleagues’ findings on ethnicity and prostate cancer have been widely discussed in the press and social media. We have used Storify to collate the main news articles, as well as a selection of comments from social media.

The research and accompanying commentary are both part of our Spotlight on prostate cancer article collection, guest edited by Sigrid Carlsson and Andrew Vickers. This collection remains open for research submissions, and you can send pre-submission enquiries to bmcmedicineeditorial@biomedcentral.com.

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