Background
Prostate cancer is the most common cancer in men and the second leading cause of cancer related deaths in men in the Western world. Not only is prostate cancer three times more likely and has a higher mortality in men with African and Caribbean ancestry than in Caucasian men, but studies have demonstrated that black men are less informed of prostate cancer and PSA testing compared to their Caucasian counterparts. Community based prostate clinics can be an alternative model of care (to GP services), in order to enhance knowledge of prostate cancer and support men in making decisions about undergoing investigations or treatment for prostate cancer.
Objectives
The objective of this study was to demonstrate the importance, feasibility and challenges of establishing a community based prostate assessment clinic targeting ‘hard to reach’ and ‘at high risk men’ in a socially deprived area of London.
Methods
The borough of Newham was chosen for the community clinic as it has one of the most ethnically diverse populations in London and also one of the worst cancer outcomes in the city. The Men’s Clinic was established in an African-Caribbean community centre in collaboration with Newham PCT, Newham University Hospital trust, the North East London Cancer Network, Prostate Cancer UK, the Department of Health, the National Cancer Action Team, Cancer Black Care and King’s College London. The clinic ran two days a week and was staffed by both medical and nursing professionals. It offered men advice on Prostate Cancer as well as PSA testing, Digital Rectal Examination, uroflowmetry and bladder ultrasound.
Results
328 men attended the clinic over the 98 days the clinic ran between December 2010 and December 2011. 46% of men who attended identified themselves as Black and 65% of all men were born outside the UK. 95% of attendees lived in deprived neighbourhoods. Overall, the vast majority of men had a poor knowledge of prostate cancer or the PSA test- Only 27% and 33% of men knew about Digital Rectal Examination (DRE) and PSA respectively. Black men were the least informed- only 16% and 13% of black men were aware of DRE and PSA. This knowledge increased substantially after attending the clinic- 70% and 65% men felt informed of DRE and PSA after attending the clinic. 96% of men choose to undergo the PSA test and DRE. Overall 9 cases of prostate cancer were diagnosed. None of these men had metastatic disease on diagnosis.
Conclusion
Community based prostate clinics are a successful method of reaching ‘hard to reach’ at-risk men with poor knowledge of prostate caner. These men would not have otherwise sought medical attention for their lower urinary tract symptoms or would not have asked for a PSA test.