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Racial disparities in prostate cancer in the UK and the USA: similarities, differences and steps forwards

Nature Reviews Urology volume 22, pages 223–234 (2025)Cite this article

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Abstract

In the USA, Black men are approximately twice as likely to be diagnosed with and to die of prostate cancer than white men. In the UK, despite Black men having vastly different ancestral contexts and health-care systems from Black men in the USA, the lifetime risk of being diagnosed with prostate cancer is two-to-three times higher among Black British men than among white British men and Black British men are twice as likely to die of prostate cancer as white British men. Examination of racial disparities in prostate cancer in the USA and UK highlights systemic, socio-economic and sociocultural factors that might contribute to these differences. Variation by ancestry could affect incidence and tumour genomics. Disparities in incidence might also be affected by screening guidelines and access to and uptake of screening. Disparities in treatment access, continuity of care and outcomes could contribute to survival differences. In both localized and metastatic settings, equal access could diminish the observed disparities in both the USA and the UK. An understanding of behavioural medicine, especially an appreciation of cultural beliefs about illness and treatment, could inform and improve the ways in which health systems can engage with and deliver care to patients in minoritized groups affected by prostate cancer. Methods of promoting equity include targeting systemic barriers including systemic racism, proportional recruitment of patients into clinical trials, diversifying the health-care workforce and facilitating care informed by cultural humility. Actively engaging patients and communities in research and intervention might enable the translation of research into increasingly equitable care for patients with prostate cancer in the UK, the USA and globally.

Key points

  • In the USA, Black men are more likely than white men to be diagnosed with prostate cancer, to be diagnosed at an younger age and with more advanced disease, and to die of prostate cancer. In the UK, the lifetime risk of being diagnosed with prostate cancer is two-to-three times higher in Black British men than in white British men; however, Black British men might be less likely to present with advanced disease than white British men.

  • Race is a social construct, but strong evidence supports elevated prostate cancer risk among men with African ancestry, including Caribbean men, Black British men, and Black men in the USA, and could be associated with known genomic variants. Differences in screening programmes, access and adherence might influence disparities in advanced disease at diagnosis, in the context of evolving public-health screening paradigms in the UK and the USA.

  • Racial variation in tumour genomic profiles has also been demonstrated; these differences might explain data suggesting that Black patients have improved response to radiotherapy, and could inform individualized treatment strategies and future research.

  • Evidence from both localized and metastatic disease in the UK and USA suggest that equal access to treatment reduces (and even eliminates) disparities in prostate cancer-specific mortality among patients who undergo treatment.

  • Health and sociocultural beliefs in the context of social determinants of health among these unique populations in the UK and the USA can influence access and adherence from screening to diagnosis to treatment.

  • Steps forward to promote equity include targeting systemic barriers including systemic racism, improving diversity in clinical research, promoting care informed by cultural humility and community-based participatory research, diversifying the health-care workforce, and improving access to clinical trials for minoritized groups. Actively engaging patients and communities in research and intervention might enable the translation of research findings into increasingly equitable care for patients with prostate cancer globally.

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Acknowledgements

E.C.D. is funded in part through the Prostate Cancer Foundation Young Investigator Award and through the Cancer Center Support Grant from the National Cancer Institute (P30 CA008748). K.N. has received personal fees from Pfizer, GSK and TESARO, Boehringer Ingelheim, travel grants from Conquer Cancer Foundation and research funding from Cancer Research UK. P.L.N. is funded in part through the National Institutes of Health (R01-CA240582). E.C.D., R.T., K.N., G.A.-M., Z.M., K.M., G.F., L.T.A.M., E.P., J.S. and R.H. are part of a collaborative effort (TRANSFORM) aimed at mitigating disparities in prostate cancer in the UK, funded by Prostate Cancer Research.

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Author notes

  1. These authors contributed equally: Edward Christopher Dee, Rebecca Todd, Kenrick Ng.

Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Edward Christopher Dee

  2. Department of Practice and Policy, Centre for Behavioural Medicine, University College London School of Pharmacy, London, UK

    Rebecca Todd, Zoe Moon & Robert Horne

  3. Department of Medical Oncology, Barts Cancer Centre, London, UK

    Kenrick Ng & Jonathan Shamash

  4. Department of Medical Oncology, Royal Free Hospital NHS Foundation Trust, London, UK

    Gloryanne Aidoo-Micah

  5. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Troy B. Amen

  6. Case Western Reserve University, University Hospital Urology Institute, Cleveland, OH, USA

    Randy Vince Jr

  7. Department of Radiation Oncology, Kaiser Permanente Northwest, Portland, OR, USA

    Vinayak Muralidhar

  8. Clinical Commissioning Group, NHS North East London, London, UK

    Katherine Mutsvangwa

  9. Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, UK

    Garth Funston

  10. Department of Health and Community Sciences, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, UK

    Luke T. A. Mounce

  11. Guy’s Cancer Centre, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, UK

    Elias Pintus

  12. Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institutes, Tampa, FL, USA

    Kosj Yamoah

  13. Department of Radiation Oncology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA

    Daniel E. Spratt

  14. Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA

    Brandon A. Mahal

  15. Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA

    Paul L. Nguyen

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Contributions

The authors contributed equally to all aspects of the article.

Corresponding author

Correspondence to Edward Christopher Dee.

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Competing interests

K.N. has received personal fees from Pfizer, GSK and TESARO, Boehringer Ingelheim, travel grants from Conquer Cancer Foundation and research funding from Cancer Research UK. V.M. is employed by Northwest Permanente. B.A.M. receives funding from the Prostate Cancer Foundation (PCF), the American Society for Radiation Oncology (ASTRO), the Department of Defense, and the Sylvester Comprehensive Cancer Center. E.P. reports receiving consulting fees from Janssen and Merck Sharp & Dohme, financial support from Bayer, and non-financial support from Amgen and Astellas. D.E.S. reports personal fees from Janssen, Blue Earth, AstraZeneca and Boston Scientific outside the submitted work. P.L.N. reported receiving grants and personal fees from Bayer, Janssen and Astellas and personal fees from Boston Scientific, Dendreon, Ferring, COTA, Blue Earth Diagnostics, Myovant Sciences and Augmenix outside the submitted work. R.H. reports grants/research support from AstraZeneca, National Institute for Health Research (NIHR) and Asthma UK (AUKCAR); honoraria/consultation fees from AbbVie, Amgen, Astellas, AstraZeneca, Biogen, Erasmus, Idec, Gilead Sciences, GlaxoSmithKline, Janssen, Merck Sharp Dohme, Novartis, Pfizer, Roche, Shire Pharmaceuticals and TEVA; and is a founder and shareholder of a UCL Business company (Spoonful of Sugar) providing consultancy on supporting patients with medicine- and treatment-related behaviours to healthcare policymakers, providers and industry. Z.M. reports paid work for UCL Business Company Spoonful of Sugar. All other authors declare no competing interests.

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Nature Reviews Urology thanks Clayton Yates, Stefan Ambs, Yaw Nyame and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

Cancer Research UK screening for prostate cancer: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/gettingdiagnosed/screening

Our Future Health study: https://ourfuturehealth.org.uk/

Prostate Cancer UK risk checker: https://prostatecanceruk.org/risk-checker

RESPOND study: https://www.respondstudy.org/

UK Cancer Patient Experience Survey: https://www.ncpes.co.uk/latest-national-results/

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Dee, E.C., Todd, R., Ng, K. et al. Racial disparities in prostate cancer in the UK and the USA: similarities, differences and steps forwards. Nat Rev Urol 22, 223–234 (2025). https://doi.org/10.1038/s41585-024-00948-x

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