Clinical presentation and initial management of black men and white men with prostate cancer in the United Kingdom: the PROCESS cohort study.
BACKGROUND
In the United States, Black men have a higher risk of prostate cancer and worse survival than do White men, but it is unclear whether this is because of differences in diagnosis and management. We re-examined these differences in the United Kingdom, where health care is free and unlikely to vary by socioeconomic status.


METHODS
This study is a population-based retrospective cohort study of men diagnosed with prostate cancer with data on ethnicity, prognostic factors, and clinical care. A Delphi panel considered the appropriateness of investigations and treatments received.


RESULTS
At diagnosis, Black men had similar clinical stage and Gleason scores but higher age-adjusted prostate-specific antigen levels (geometric mean ratio 1.41, 95% confidence interval (95% CI): 1.15-1.73). Black men underwent more investigations and were more likely to undergo radical treatment, although this was largely explained by their younger age. Even after age adjustment, Black men were more likely to undergo a bone scan (odds ratio 1.37, 95% CI: 1.05-1.80). The Delphi analysis did not suggest differential management by ethnicity.


CONCLUSIONS
This UK-based study comparing Black men with White men found no evidence of differences in disease characteristics at the time of prostate cancer diagnosis, nor of under-investigation or under-treatment in Black men.
Evans
S
S
Department of Social Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
Metcalfe
C
C
Patel
B
B
Ibrahim
F
F
Anson
K
K
Chinegwundoh
F
F
Corbishley
C
C
Gillatt
D
D
Kirby
R
R
Muir
G
G
Nargund
V
V
Popert
R
R
Wilson
P
P
Persad
R
R
Ben-Shlomo
Y
Y
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy*; D012189:Retrospective Studies; D006113:United Kingdom; D044465:White People
D017430:Prostate-Specific Antigen