Black men are less likely to choose investigation for symptoms that may herald prostate cancer, at all levels of risk, a UK study has found.

A total of 555 men (286 black, 269 white), aged ≥ 40, were approached while awaiting a GP appointment and recruited to the study from four GP surgeries in Bristol.

They were presented with three different vignettes of possible prostate cancer symptoms and the estimated risk of prostate cancer for each vignette, see table 1.

Participants were asked if they would choose diagnostic investigation if they had these symptoms, and to select their reason for choosing or declining investigation from a predefined list.

Overall, 81% of men opted for investigation. There was a significant difference between the proportion of white men (94%) and black men (70%), P < 0.001, making this choice. This difference was most marked at lower risk levels – in the 2% risk band, 44% of black men chose investigation, compared with 91% of white men, see table 1.

There were also marked differences in the main reasons for opting for testing: 72% of white men who chose to be tested did so because this would allow cancer to be detected earlier compared with 45% of black men. However, 41% of black men who chose to be tested did so for ‘peace of mind’, a much higher percentage than in white men (15%).

Nearly half the participants who declined investigation, 45% of black men and 43% of white men, chose not to be tested because they felt the cancer risk was not very high.

However, 37% of black men who declined testing stated that the main reason was ‘I would rather not know I have cancer’, compared with 14% of white men.

Afro-Caribbean ethnicity has long been recognised as a risk factor for prostate cancer. In the UK, black men are approximately three times more likely to be diagnosed with prostate cancer compared with white men of the same age and mortality rates are 35% higher in black than white men.

This study emphasises ethnic differences in attitudes towards prostate cancer diagnosis, and a different approach to risk. It is important therefore to be aware of these differences when discussing investigations with Afro-Caribbean men. Better targeting of PSA testing in higher risk black men is vital if we are to lessen the disparate burden this disease has on the Afro-Caribbean population.

Dr Jonathan Rees