Prostate Cancer and Black men: What You Need to Know

Black men in the UK are around twice as likely to develop and to die from prostate cancer compared with white men (Lloyd et al., BMC Medicine 2015 — Prostate Cancer UK / Public Health England). The reasons are a combination of genetic factors (including the rs72725854 variant on chromosome 8q24, which activates androgen-driven prostate cancer pathways; Walavalkar et al., Nature Communications 2020), environmental factors (vitamin D levels, chronic inflammation, diet), and unequal access to early screening. The biological risk is real — but the outcome gap is largely addressable through earlier detection.

Prostate Cancer UK and most UK specialist centres recommend that Black men speak to their GP about a PSA blood test from age 45 — and from age 40 if there is a family history of prostate cancer. The general-population recommendation is age 50. Earlier testing matters because Black men more often develop aggressive prostate cancer at a younger age (Prostate Cancer UK PSA Consensus, 2024).

Early-stage prostate cancer usually has no symptoms — which is why PSA testing matters. When symptoms do appear, they may include needing to urinate more often (especially at night), a weak or interrupted urine flow, difficulty starting urination, blood in urine or semen, and unexplained pelvic or lower back pain. By the time symptoms are present, the cancer may already have spread, so screening through a PSA blood test before symptoms develop is strongly recommended.

The treatment options are the same as for any other man — active surveillance, surgery, radiotherapy, hormone therapy, and focal therapy (HIFU, NanoKnife or cryotherapy). What differs is the importance of early detection. When Black men are diagnosed early with localised cancer, they have access to the full range of options, including focal therapy. When detection is late, choices narrow. This is why screening matters more, not why treatment differs.

Focal therapy treats only the cancer-affected area of the prostate rather than removing or irradiating the whole gland. This preserves the surrounding nerves, sphincter and healthy tissue — meaning published series report urinary continence preserved in 96–100% of men and erectile function preserved in 74–95% of men after focal therapy (Hopstaken et al., European Urology 2022). For Black men diagnosed in their 50s and 60s, who often have many active years ahead, this matters more than the marginal differences in cancer cure rates.

PSA testing is the most useful screening tool currently available, but it is not perfect. A high PSA does not always mean cancer, and a low PSA does not always rule it out. For Black men, PSA testing is particularly valuable because of the higher baseline risk — most specialist centres recommend treating any unexplained rise seriously and following up with MRI imaging rather than dismissing it.

PSA testing is available free from your GP — you can request it directly from age 45 (or earlier if you have a family history). It is also available through community programmes including the Errol McKellar Foundation's barbershop initiative and various faith-based outreach programmes. Private screening with same-week results is available at The Focal Therapy Clinic across our London, Birmingham, Bristol, Oxford and Windsor locations.