Men's things XXXIII: Prostate Cancer Screening and UK Black Men

A sobering statistic

The statistics in the UK show that Black men are twice as likely to get prostate cancer and, consequently, twice as likely to die from the disease. In plain numbers, this means that 1 in 4 Black men will encounter the disease in their lifetime.

So, it was quite disappointing when, in November 2025, the UK National Screening Committee (NSC) advised against routine prostate cancer screening for the majority of men.

That advice included the very men most susceptible to the disease, and it was justified by concerns over the overdiagnosis and overtreatment of what might essentially be benign conditions.

Blog - Men's things XXVIII: Shame, no national prostate cancer screening

To withhold the opportunity from a cohort that is most medically affected and usually clinically ignored, especially given the tendency of such men to be culturally diffident on intimate matters, where masculinity, machismo, and sexual virility are taken to demonstrate manliness and personify manhood, was as close to unconscionable as one could get.

Renewed hope: TRANSFORM

It is therefore gratifying that, two days ago, the TRANSFORM prostate cancer screening trial received further funding. The trial, which began in autumn 2025 after being proposed in spring 2024, will now invite men at the highest risk of prostate cancer to benefit from research, early detection, and more effective treatments. [GOV.UK: Major expansion of research and treatment for prostate cancer]

All eligible Black men will be invited to participate in this initiative, which is jointly funded and supported by Prostate Cancer UK and the National Institute for Health and Care Research (NIHR). This should accelerate community engagement and deepen it, particularly amongst Black men.

In June 2026, when stage 2 of the trial commences, all eligible Black men will be invited, including Black men who:

• are aged 45 to 74
• are resident in the UK
• have not had a PSA test or prostate MRI scan in the last 5 years

My own journey

Two years after my prostate cancer diagnosis, and twenty months after completing radical radiotherapy, the prognosis is good. My PSA is at the lowest reading it has been since I was first screened in February 2024.

I urge every Black man to take up this screening opportunity, all the more so if he carries the BRCA2 gene variant and has a family history of prostate, breast, pancreatic, or ovarian cancer.

Know the warning signs

Beyond that, a man should have his prostate checked if he gets up multiple times at night to urinate, waits a while to start, strains to begin, does not feel he has fully emptied his bladder after a visit to the toilet, or has pressing urges to pass urine.

Not every prostate enlargement is indicative of cancer, but it must be investigated by medical personnel. This is good news for Black men; now step forward and take control of your health.

Blog - Men's things XXXII: For the Boys in the Room: Why Your PSA Matters

Blog - Photons on the Prostate: Three Things I Wish I'd Known

Blog - Men's things: Prostate Cancer blogs

A Google NotebookLM AI Podcast on this blog

Men's things XXVIII: Shame, no national prostate cancer screening

An Unexpected Conclusion

I catch up on the news through the refined medium of chat shows, so I was unaware of the day's developments when my friend called to get an opinion. It was the news that national prostate cancer screening has not been recommended for men in the UK.

Whilst I am disappointed by the development, the science and research might suggest it could cause more harm; men could be diagnosed and overtreated for something benign. Because the usual growth rates for prostate cancer are quite long-term, stretching into more than a decade, immediate intervention is not always needed.

I appreciate all those arguments, but I can only share my own experience.

Pushing for Action

Firstly, the decision to get a PSA test was primarily at my own instigation and insistence. My GP had blood test results suggesting I had an anaemic deficiency for over two months, and did nothing about it until I asked why a reading was off the scale. During that investigation, I tacked on the PSA test.

As a black man aged 58, I fell into the cohort of those who could be affected by prostate cancer. Then my father indicated that he had it too, though I could not conclusively ascertain the facts.

The urinary symptoms of incomplete emptying or urgency I had attributed to the expected rather than the unusual. I was not expecting anything untoward.

Towards a Cancer Diagnosis

In early February 2024, the PSA reading was borderline on the high side of the normal range at 3.5 ng/ml. The other issue was that I had folic acid deficiency anaemia. I got a prescription for folic acid supplements and returned for another blood test at the end of March 2024.

By then, my folic acid levels had fallen outside the normal range, but the more concerning issue was the PSA at 4.0 ng/ml over the course of seven weeks.

The doctor then took the initiative to invite me to discuss this reading and conducted a digital rectal examination (DRE). His conclusion was an enlarged prostate gland with no nodules, but we needed to determine why.

This led to a referral to a hospital urology department, which, within weeks, scheduled a multiparametric MRI (mpMRI) scan at the end of April.

Challenging the Orthodoxy

At which point, I was reading up about tests, results, and indicators in the diagnostic path for prostate cancer. I then got an appointment with the urology department to discuss the MRI scan results.

We had barely exchanged greetings when the specialist literally blurted out, "We need to do a biopsy." No assessment, review, or discussion before telling me that. I pushed back and asked what the reasons were behind the decision, as the whole thing was both shocking and a surprise. The specialist would win no prizes for bedside manner.

Along with the many questions I asked, the answer that made me acquiesce was when he told me the PIRADS score was 4.

That result meant there was something concerning that had to be checked. There was no comfort with the ultrasound-guided transperineal biopsy of the prostate; even the lidocaine injections were painful, but I braced myself.

Cancer of the Prostate Gland

I had an appointment to review the results in mid-June. But my medical data in another hospital was merged into another assessment in early June, and there I learnt of the diagnosis of adenocarcinoma of the prostate gland.

When I met the urologist at the urology department, I told him I already knew, and we should cut to the chase. It was Stage 2 cancer, a Gleason score of 7 (represented as 3+4), contained in the prostate gland, and immediate treatment was recommended. I opted for radiotherapy.

In the process, I consulted with Prostate Cancer UK. I realised I could only be put on the longer hypofractionated radiotherapy over 20 working days, as my prostate was too enlarged for surgery to consider what could be saved of any sexual function, and brachytherapy could lead to serious complications.

You Always Excise the Cancer

Prostate Cancer UK felt I should have opted for active surveillance, but I had come so far in the medical analysis to back out. Apart from the fact that, besides the recommendation to treat it, I was not going to endure the presence of cancer in my body, waiting to see what it might do in years or decades.

Whilst the side effects were close to debilitating, they were manageable with good advice from the cancer health nurse consultant that my company recommended as I began treatment.

As prostate cancer leads the cause of deaths from cancer in men in the UK, and it impacts black men twice as much, the decision not to recommend national screening is quite unfortunate.

Get Screened and Scream Too

Even those with the BRCA gene mutation that suggests greater susceptibility to cancer will not find that out unless they are screened for it, probably in a separate medical checkup.

Reviewing all my medical notes, I cannot find any indication of any BRCA1 or BRCA2 gene mutation, and yet I have had two episodes of cancer malignancy in the space of 15 years.

Obviously, it means men must have a voice in their individual medical situations and advocate for the necessary interventions towards the best outcomes.

From my perspective, every time I have a platform to speak about men's health, I will say: if you're a black man over 45, you need to get the PSA test and go the full course until you are satisfied everything is fine.

Then, if anyone in your family (and that is mother, father, sister, or brother) has had cancer, get checked too. Demand to be seen as a person before you become a statistic.

Putting your health first, above any cultural, societal, or personal embarrassment, is paramount. Prostate cancer is treatable, especially when caught early. The lack of a national screening programme does not make it less incumbent on every man to step up and be part of ensuring that prostate cancer is no longer the biggest cause of cancer deaths in men.

Thank you.

BBC News: Streeting 'examining evidence' after experts advise against prostate cancer screening for most men

References

Blog - Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Photons on the Prostate - XVIV - I Just Can't Wait

Blog - Men's things XXVII: The inconvenience of incontinence

Blog - Men's things - Prostate Cancer blogs

Key

The PSA unit ng/ml is nanograms per millilitre.

Men's things XXVII: The inconvenience of incontinence

We Need a Screening Programme

At any opportunity, especially when I encounter black men, I bring up men's things and prostate cancer. However, what has surprised me is that many of my white colleagues have had some exposure to this matter, usually through older members of their families: their fathers or fathers-in-law.

This might make people think prostate cancer is a middle-aged affliction in black men and a geriatric condition in white men. We should be careful not to delude ourselves into thinking this is the case. It affects all men, and whilst there are extenuating factors relating to race, age, and family history of cancer, we all need checkups, early ones too, to ensure that abnormalities, when found, are promptly dealt with.

This points to the need for widespread screening for prostate cancer, rather than leaving it to individuals to demand it themselves.

Some Aftereffects of Prostate Cancer

From my experience, almost 18 months after a prostate cancer diagnosis and 13 months after radiotherapy, I have come quite a long way, and I am grateful for that. The issues I still deal with are nighttime insomnia, some fatigue (though not to the point of being debilitating), occasional incontinence (more with the bladder than the bowel), and a lack of any sexual drive, which may also present as erectile dysfunction.

Inconvenient as incontinence might be, I manage it quite well: my Radar key for disabled toilets, my Just Can't Wait card to request the use of a toilet elsewhere, and I wear incontinence underwear, or I line my underwear with incontinence pads. These all save you the greater embarrassment of publicly visible mishaps, and better that than pushing up a gravestone in some nondescript cemetery.

Making the Best of It

Still on incontinence: the bladder aspect is usually that sudden and pressing urge, where you are never able to get to a toilet soon enough before wetting yourself. When it comes to the bowels, it is a feeling somewhere between the urge and constipation. Having already had a movement, it doesn't feel empty, and yet you can't make it happen. That presents some discomfort and anxiety whilst you hope it clears up soon.

With a basic consultation at a regular pharmacy, you can get medication to combat issues with erectile dysfunction. Ultimately, you work with or around the problems for the best outcomes in experience and wellbeing. Choosing not to be defined by either manliness or manhood can also be the key to contentment and happiness.

The walnut-sized prostate gland can be life-threatening if enlarged and cancerous, but once treated and kept under medical observation, the inconvenience should not take away from the joy of living.

AI Postscript

As I have AI to review my blogs for grammar, spelling, and contextual checking, I was quite impressed with this summary of the blog: The key was asking: "Would Akin still recognise this as his own thought, just expressed more clearly?" If the answer was no, I didn't restructure it. Your voice is situated in the precise intersection of being black, male, professionally engaged, medically informed, personally affected, and committed to demystifying this subject for others.

References

Blog - Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Photons on the Prostate - XVIV - I Just Can't Wait

Blog - Men's things XXVI: Let's avoid the stigma of prostate cancer

Blog - Men's things - Prostate Cancer blogs

Men's things XXVI: Let's avoid the stigma of prostate cancer

A stigma on the prostate

Much as I have openly written about my account of being diagnosed with malignant prostate cancer, a Twitter exchange between two young black men left me wondering about the kind of stigma that associates with situations we as human beings might have little control over.

It has taken me months to process this experience before I found the opportunity to write about it. These young men in Africa were in what might be a phase of explorative bisexuality or homosexuality, full of youth, bravado, and machismo. One should not deny the youth their virility, vigour, and vitality.

Rather a living older man

However, they were not content with their good fortune without finding others to pull down to feel better about themselves. In this case, they took on the topic of older black men who had become less sexually able because of prostate cancer. The exchange was in jest, levity, and mockery; it cut quite deep.

Obviously, having good health is amazing, and some of us have the kind of genes that we may never be susceptible to any infection or disease, and that is good for them.

I have had two different encounters with aggressive cancers some 15 years apart that were successfully treated, and I am grateful for the gift of medicine, the gift of faith, and the wonder of life. I have been very fortunate.

Youthful delusions of invincibility

Then again, we must be careful of the hallucinatory qualities of the elixir of youth that confers invincibility bordering on immortality on us, such that we forget the occasional frailties of the human organism and the malfunctioning of parts of the human body that could present with life-threatening conditions, easily ignored until they become untreatable.

I have made it a point to always discuss "men's things" with any black man I meet, in groups or during the occasional encounter on a taxi ride. We need to be aware that one in four black men might encounter prostate cancer, and that is twice the susceptibility compared to the wider population.

Yet, there is no widespread screening for the disease, such that it becomes incumbent on the individual to get tested and screened by making the enquiry of their medical practitioners for themselves.

Health trumps sexual prowess

Whilst doing this, we must have the mindset of not being embarrassed about seeking a medical opinion on the health of our private parts and welcoming whoever has the medical expertise to ensure we are in the clear. It should never matter what the gender of the specialist is; they are there to help you, not violate you.

I fear that men who have treasured their unquenchable sexual libido will face an almost insurmountable challenge to their manhood before they engage the authority of medical science to ascertain if they are alright. The time wasted in addressing this personal battle can be quite costly.

I faced up to my doctor to address out-of-range results of blood tests, insisted that whatever it was be seen to, and tacked on the Prostate-Specific Antigen (PSA) test because I fell in the cohort of those who might be susceptible. I was over 45, and my father had, before without verification, said he had prostate cancer.

Be a man, get checked

What matters is if you are black, over 45, or have had male or female members of your family diagnosed with cancer, you need to go for checkups.

Also, if you have issues with your urinary system (urgency, not emptying your bladder fully, straining to start urination, waking up multiple times at night to urinate), you should have your prostate health checked.

Not every case of prostate enlargement indicates cancer, but every reason for that condition needs to be determined and treated.

Finally, being able to perform sexually is not what defines a man, and what use is a dead man who had gone too soon because they were too coy about having their prostate gland checked? To those young men: all erections will eventually fail; life is more precious than all that.

References

Blog - Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Photons on the Prostate - XVIV - I Just Can't Wait

Blog - Men's things XXV: Prostate cancer under control

Blog - Men's things - Prostate Cancer blogs

Men's things - XXIV - A presentation

Sharing my prostate cancer story

Within the last fortnight, I attended a gathering of black men in Manchester and Liverpool, where I was invited to tell my story about my experience with prostate cancer.

The story on its own could be compelling, as I do have friends and acquaintances, even strangers asking for advice and direction about how to navigate these issues, that I term, "Men’s things".

However, in such a semi-formal setting under the auspices of a registered charity, I felt it should not be a typical story-telling setting, but one where whoever listened learnt something and could act on it.

What the prostate gland does

To that end, I created slides with some images, because in all previous presentations I have attended on the topic of prostate cancer, the issue of the function of the prostate gland as a muscular switch between urination and ejaculation was not clear. For instance, I learnt this long after I had commenced radiotherapy treatment for prostate cancer.

Secondly, I had only found one image that gave a close-up view of how an enlarged prostate gland can present symptoms of difficulty or discomfort with the ease of urination. That visual image alone seemed to get men thinking about having checks on their prostate health.

Courtesy of NHS Overview of Benign Prostate Enlargement

Your active participation in your health, matters

On this perspective, I wove a story around my curiosity about some unusual blood test results outside normal ranges, through insistence to my GP for tests, the referral for further investigation, leading to a cancer diagnosis, then the treatment of prostate cancer, and the post-treatment side effects.

Beyond that is the need for black men to participate in surveys, especially when invited for bowel cancer screening, why men’s things should be more widely and openly discussed, and how early detection saves lives.

What I hoped men would take away from my presentation was that, “All prostate issues are not indicative of cancer, but every prostate enlargement should be investigated for cause and possible treatment.”

My presentation slides

Blog - Men's things - Prostate Cancer blogs

Blog - Photons on the Prostate - XIII

References

MedScape: International Prostate Symptom Score (IPSS) Calculator

Prostate Cancer UK: Risk Checker

Men's things - III

Gibbering not to the wreck

I suppose it was in a flux of apprehension that I forgot my notes, notepad, and pen as I made for my early consultation. Fortunately, I had printed out the Canadian paper that gave a cautionary note on avoidable biopsies and that was my reference document as I boarded the luxury Uber BMW that dropped me off in the maze of the Manchester Royal Infirmary buildings unsure of where I needed to go, until a nurse gave me directions.

At the reception, I was asked to give a urine sample which might well have been under duress as I waited to see the consultant. He had decided I must have a Transperineal Prostate Biopsy, but I had questions, his approach was quite paternalistic even as he implied there was no pressure to go ahead with the biopsy. It was my decision to make, only if I had the essential data, for that purpose.

Decision time truncated

However, my PSA reading was high, increasing dramatically over a 7-week monitoring, the DRE (Digital Rectal Examination) suggested an enlarged but smooth prostate organ, the next thing I needed to know was the PI-RADS (Prostate Imaging Reporting and Data System) score pertaining to the mpMRI (multiparametric MRI) scan I had, just over two weeks before. On a scale of 1 to 5, with 1 being benign and 5 suggesting cancerous lesions, the assessment was 4. [Radiopaedia: PI-RADS]

With that conclusion, I guess I had no other alternative than to go ahead with the biopsy. No time to waste with that kind of assessment. I opted for the biopsy even as the life-or-death implications dawned on me with the sudden realisation of the loneliness that accompanies decisions like this. Your mortality becomes a smorgasbord of conflicting thoughts, you seek a resolution and a determination, with no time to reflect on the import of the moment.

Let’s do this thing

Soon, I was with the doctor who was to do the biopsy, his computer was acting up, and his pen not inking the paper. I lent him my pen that the receptionist had given me to take notes of the questions and points I needed to assess my understanding of the situation, and he explained through drawings what was to be done.

I still had the option not to go ahead with the biopsy, I asked to see the MRI scan, and he zeroed in on the T2 scan explaining the abnormalities on one side that presented the need for a biopsy. [Radiopaedia: Prostate MRI - T2 Weighted Imaging explained here.]

Then, I was prepped for the biopsy, I changed from shoes into my slippers and only had to take off my trousers and underwear to wear a hospital tunic gown.

Ouch! And much else

I swallowed 3 antibiotics Ciprofloxacin 250mg tablets and about 15 minutes later, I was invited into the biopsy room. splayed out as if to be examined by an obstetrician in the most vulnerable state in stirrups, a digital inspection, then an ultrasound probe, a cold antiseptic wipe, and an icy cold spray even so painfully close to beyond endurance, a light introduction to discomfort as I looked up at the scenery of a tropical beach, psychology that was good for the imagination, but I felt better closing my eyes.

I grimaced and let out a shriek, once or twice as the local anaesthetic was injected, I was probably given 6 injections.

Again, the ultrasound probe was inserted and then the doctor began taking the biopsies, I felt much unease and on two occasions pain, the biopsy needle sounded like a stapling gun, and that happened about 9 times.

All done for now

I did not feel at all woozy, and when it was done, my blood pressure was taken with what looked like an old mercury sphygmomanometer with a dial and a stethoscope; the memories of the traditional ways flooded back, before I was chaperoned back to the dressing room.

As I left the biopsy room, I was offered tea and biscuits. I had my first urination which was clear, dressed up and filled in a survey. Results in 2 to 3 weeks, an ordeal in some way and probably a lifesaving act of catching something early.

My advice is not to be too coy about men's things, better to be under medical supervision with knowledge of what needs to be done, than leaving it out of fear or machismo.

It may not be a rite of passage, but I was first at the urology department this morning, and then more chairs were set up, it was like the Church of the Prostate Screening, many men come to worship there, in silent contemplation of what life ahead might be. I had humour to offer that made some laugh. God help us all.

Reference

Diagnosis of prostate cancer: the implications and proper utilization of PSA and its variants; indications and use of MRI and biomarkers [Canadian Journal of Urology] February 2020. (PDF)

Blog - Men's things

Blog - Men's things - II