A recent investigation by experts at the University of Exeter reveals that a commonly employed prostate cancer test might pose an elevated risk of overdiagnosis among black men. Prostate-specific antigen (PSA) testing serves as the initial diagnostic step in the UK for men experiencing urinary symptoms, such as frequent urination or blood in urine. Additionally, men over 50 without symptoms can request a blood test from their GP.

Published in BMC Medicine, the study aimed to assess the PSA test’s effectiveness in identifying prostate cancer across different ethnic groups, particularly given the higher incidence of prostate cancer in black men in the UK. While it is known that black men are more frequently diagnosed with prostate cancer, the study aimed to clarify whether their outcomes differed from those of their British-white counterparts.

Examining records of 730,000 men, the research, funded by the National Institute for Health and Care Research (NIHR), Cancer Research UK, and the Higgins Family, investigated the incidence of prostate cancer diagnoses following elevated PSA test results. Remarkably, over 80 percent of participants exhibited normal PSA levels, irrespective of ethnicity. Yet, the study unveiled, for the first time in a robust UK dataset, ethnic variations in PSA levels, with black men having higher levels than white men and Asian men displaying the lowest levels.

Further analysis disclosed that black men had the highest rates of prostate cancer diagnoses following elevated PSA results compared to white and Asian men. However, when examining advanced prostate cancer rates, there was minimal disparity between black and white men, implying that the relatively higher PSA levels might be influencing the diagnosis of prostate cancer in black men.

Prostate cancer constitutes a quarter of new cancer cases in men, with approximately 52,000 diagnoses annually in the UK alone. It is the second-leading cause of cancer-related death in UK men, and early diagnosis significantly improves survival rates.

The study underscores concerns about PSA testing, as only one in three men with a positive PSA test has cancer, and one in seven men with prostate cancer exhibits normal PSA levels. The findings suggest that black men might undergo more diagnostic testing, including prostate MRI and biopsy, due to their naturally higher PSA levels.

Dr. Tanimola Martins, Senior Research Fellow and Lecturer at the University of Exeter, emphasized the historical underrepresentation of British black, Asian, and other ethnic minority groups in cancer research. The study advocates for a more precise and accurate approach to prostate cancer diagnosis to avoid unnecessary biopsies and psychological distress.

Naser Turabi, Director of Evidence and Implementation at Cancer Research UK, highlighted the potential harm caused by the PSA test to black men, urging the need for further research to develop an effective and accurate test that saves lives and reduces unnecessary treatment.

The study encompassed 649,445 white men, 37,827 black men, and 31,053 Asian men, revealing consistently lower PSA levels, fewer cancer diagnoses, and lower rates of advanced prostate cancer in Asian men. Conducted using data from general practices in England, the study adds crucial insights to prostate cancer diagnosis, urging a more inclusive and precise approach for everyone, regardless of ethnicity.

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