Who is high risk?

Black men are at significantly higher risk of developing prostate cancer, often at a younger age, and may experience more aggressive disease.

Infographic stating which patients are high-risk for prostate cancer. Full description below.

High-risk individuals include

  • All Black men aged 45 and above, regardless of family history.
  • Men with a first-degree relative (father, brother, son) diagnosed with prostate cancer.
  • Men with multiple family members affected or known hereditary/genetic risk factors (e.g., BRCA1/BRCA2 mutations). These men may benefit from assessment earlier than age 45.

It is important to recognize that risk is cumulative - ethnicity, family history, and genetics all interact. Keeping an updated record of family history during consultations is critical for identifying who should be prioritized for discussion and screening.

When to start conversations

Proactive discussions about prostate health should begin

  • From age 45 for Black men without a strong family history.
  • Earlier (often age 40–45) for those with a significant family history or known genetic risk.

Suggested phrasing for initiating conversations

“Because of your ethnicity and family history, it’s important to talk about your prostate health. A simple blood test called PSA can help detect problems early, when treatment is most effective.”

Practical actions in practice

  • Use electronic patient records to identify Black men aged 45+.
  • Send invitations for consultations or proactively offer opportunistic conversations during routine appointments.
  • Record discussions in the patient records, including PSA decisions, consent, and shared decision-making outcomes.

Infographic stating PSA testing steps. Full description below.

PSA Testing Steps

  1. Explain risk factors and the benefits/limitations of PSA testing.
  2. Offer PSA testing where appropriate.
  3. Discuss possible outcomes and next steps.
  4. Document the shared decision-making discussion in the patient record.

When to refer

Timely referral to urology is essential to ensure early diagnosis and treatment.

Consider referral when:

  • PSA levels exceed age-specific thresholds or show rapid rises over time.
  • Abnormal digital rectal examination (DRE) findings - where applicable
  • Patient preference after shared decision-making regarding further investigation.

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