Metcalfe C et al. (2008) Pathways to diagnosis for Black men and White men found to have prostate cancer: the PROCESS cohort study. Br J Cancer 99: 1040–1045

The Prostate Cancer in Ethnic Subgroups (PROCESS) study has shown that, in the UK, black men are three times more likely than white men to develop prostate cancer. Similar studies in the US have shown that black men are 2.4 times more likely to die from prostate cancer than are white men, but evidence suggests that black men have worse access to health care. Metcalfe et al. investigated whether this was the case in the UK, or if other factors contributed to the increased incidence of prostate cancer in black men.

The team retrospectively analyzed data from the PROCESS cohort study on men diagnosed with prostate cancer in Bristol and London. Hospital records and questionnaires were used to collect data. Black men (n = 547) presented with prostate cancer approximately 5 years earlier than white men (n = 1,319); the mean age at diagnosis was 67.9 years (SD 7.3 years) and 73.3 years (SD 8.8 years), respectively. No substantial differences were observed between the two groups with regard to knowledge about prostate cancer, comorbidities and symptoms, and delays in presentation of symptoms to a primary care practitioner. Black men were more likely to be referred to a hospital, and had higher PSA levels than age-matched white counterparts.

Metcalfe and colleagues found no differences in the access to diagnostic services or diagnostic pathways taken by the two groups of patients. Consequently, the difference in incidence may be due to differences in disease biology between the two groups of men.