title: Pathways to diagnosis for Black men and White men found to have prostate cancer: the PROCESS cohort study.
abstract: Black men in England have three times the age-adjusted incidence of diagnosed prostate cancer as compared with their White counterparts. This population-based retrospective cohort study is the first UK-based investigation of whether access to diagnostic services underlies the association between race and prostate cancer. Prostate cancer was ascertained using multiple sources including hospital records. Race and factors that may influence prostate cancer diagnosis were assessed by questionnaire and hospital records review. We found that Black men were diagnosed an average of 5.1 years younger as compared with White men (P<0.001). Men of both races were comparable in their knowledge of prostate cancer, in the delays reported before presentation, and in their experience of co-morbidity and symptoms. Black men were more likely to be referred for diagnostic investigation by a hospital department (P=0.013), although general practitioners referred the large majority of men. Prostate-specific antigen levels were comparable at diagnosis, although Black men had higher levels when compared with same-age White men (P<0.001). In conclusion, we found no evidence of Black men having poorer access to diagnostic services. Differences in the run-up to diagnosis are modest and seem insufficient to explain the higher rate of prostate cancer diagnosis in Black men.
authors.affiliation: Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. Chris.Metcalfe@bristol.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Metcalfe
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.forename: F
authors.initials: F
authors.lastname: Ibrahim
authors.forename: B
authors.initials: B
authors.lastname: Patel
authors.forename: K
authors.initials: K
authors.lastname: Anson
authors.forename: F
authors.initials: F
authors.lastname: Chinegwundoh
authors.forename: C
authors.initials: C
authors.lastname: Corbishley
authors.forename: D
authors.initials: D
authors.lastname: Gillatt
authors.forename: R
authors.initials: R
authors.lastname: Kirby
authors.forename: G
authors.initials: G
authors.lastname: Muir
authors.forename: V
authors.initials: V
authors.lastname: Nargund
authors.forename: R
authors.initials: R
authors.lastname: Popert
authors.forename: R
authors.initials: R
authors.lastname: Persad
authors.forename: Y
authors.initials: Y
authors.lastname: Ben-Shlomo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D015331:Cohort Studies; D006297:Health Services Accessibility; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D044465:White People
references.citation: Eur Urol. 2008 Jan;53(1):99-105
references.pmid: 17368710
references.citation: JAMA. 2005 May 4;293(17):2095-101
references.pmid: 15870412
references.citation: Int J Cancer. 2007 Oct 1;121(7):1571-8
references.pmid: 17450530
references.citation: Urology. 2006 Jul;68(1):89-93
references.pmid: 16844451
references.citation: BMJ. 1994 May 14;308(6939):1284-7
references.pmid: 8205024
references.citation: Lancet. 2003 Mar 8;361(9360):859-64
references.pmid: 12642065
references.citation: Int J Cancer. 2008 Jul 15;123(2):430-435
references.pmid: 18452170
references.citation: BJU Int. 2007 Oct;100(4):733-7
references.pmid: 17662075
references.citation: Br J Cancer. 2005 Jun 6;92(11):1971-5
references.pmid: 15900296
references.citation: Eur Urol. 2003 Sep;44(3):294-302
references.pmid: 12932926
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Mar;17(3):636-44
references.pmid: 18349281
references.citation: Cancer Detect Prev. 2007;31(1):29-34
references.pmid: 17303347
references.citation: Occup Environ Med. 2003 Sep;60(9):634-42
references.pmid: 12937183
references.citation: Prostate. 2005 Feb 15;62(3):243-52
references.pmid: 15389726
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716