AbstractIn 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.

摘要在美国，黑人男性被诊断患有前列腺癌和死于前列腺癌的可能性大约是白人男性的两倍。在英国，尽管黑人男性的祖先背景和医疗保健系统与美国黑人男性截然不同，但英国黑人男性被诊断出患有前列腺癌的终生风险是英国白人男性的两到三倍，而英国黑人男性死于前列腺癌的可能性是英国白人男性的两倍。

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.

对美国和英国前列腺癌种族差异的研究突出了可能导致这些差异的系统性，社会经济和社会文化因素。祖先的变异可能会影响发病率和肿瘤基因组学。发病率的差异也可能受到筛查指南以及筛查的获取和接受的影响。

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.

治疗机会，护理连续性和结果的差异可能会导致生存差异。在局部和转移性环境中，平等获取可以减少美国和英国观察到的差异。对行为医学的理解，特别是对疾病和治疗的文化信仰的理解，可以告知和改进卫生系统可以参与的方式，并为受前列腺癌影响的少数群体的患者提供护理。

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 p.

促进公平的方法包括针对系统性障碍，包括系统性种族主义，将患者按比例招募到临床试验中，使医疗保健队伍多样化，以及促进以文化谦逊为基础的护理。积极让患者和社区参与研究和干预可能有助于在英国，美国和全球范围内将研究转化为对前列腺癌患者越来越公平的护理。关键p。

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..

在美国，黑人男性比白人男性更有可能被诊断出患有前列腺癌，被诊断出的年龄更小，疾病更严重，并死于前列腺癌。在英国，英国黑人男性被诊断患有前列腺癌的终生风险是英国白人男性的两到三倍；然而，与英国白人男性相比，英国黑人男性患晚期疾病的可能性较小。。

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..

种族是一种社会结构，但有力的证据支持非洲血统男性（包括加勒比海男性，英国黑人男性和美国黑人男性）患前列腺癌的风险升高，并且可能与已知的基因组变异有关。在英国和美国不断发展的公共卫生筛查范式的背景下，筛查计划，获取和依从性的差异可能会影响诊断时晚期疾病的差异。。

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.

肿瘤基因组图谱的种族差异也得到了证实；这些差异可能解释了数据表明黑人患者对放疗的反应有所改善，并且可以为个体化治疗策略和未来的研究提供信息。

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.

来自英国和美国局部和转移性疾病的证据表明，平等获得治疗可以减少（甚至消除）接受治疗的患者前列腺癌特异性死亡率的差异。

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.

在英国和美国这些独特人群中，健康和社会文化信仰在健康的社会决定因素的背景下可以影响从筛查到诊断到治疗的获取和依从性。

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.

促进公平的步骤包括针对系统性障碍，包括系统性种族主义，改善临床研究的多样性，促进以文化谦逊和社区参与性研究为基础的护理，使卫生保健工作人员多样化，以及改善少数群体获得临床试验的机会。

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..

积极让患者和社区参与研究和干预可能有助于将研究结果转化为对全球前列腺癌患者越来越公平的护理。。

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Download referencesAcknowledgementsE.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.

下载referencesAcknowledgementsE。C、 D.部分资金来自前列腺癌基金会青年研究员奖和国家癌症研究所（P30 CA008748）的癌症中心支持资助。K、 联合国收到了辉瑞（Pfizer）、葛兰素史克（GSK）和特萨罗（TESARO）、勃林格殷格翰（Boehringer Ingelheim）的个人费用，征服癌症基金会（Converge Cancer Foundation）的旅行补助金以及英国癌症研究所（Cancer research UK）的研究资助。

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.Author informationAuthor notesThese authors contributed equally: Edward Christopher Dee, Rebecca Todd, Kenrick Ng.Authors and AffiliationsDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USAEdward Christopher DeeDepartment of Practice and Policy, Centre for Behavioural Medicine, University College London School of Pharmacy, London, UKRebecca Todd, Zoe Moon & Robert HorneDepartment of Medical Oncology, Barts Cancer Centre, London, UKKenrick Ng & Jonathan ShamashDepartment of Medical Oncology, Royal Free Hospital NHS Foundation Trust, London, UKGloryanne Aidoo-MicahDepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USATroy B.

P、 L.N.部分资金来自美国国立卫生研究院（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.和R.H.是旨在缓解英国前列腺癌差异的合作努力（TRANSFORM）的一部分，由前列腺癌研究资助。作者信息作者注意到这些作者做出了同样的贡献：爱德华·克里斯托弗·迪（Edward Christopher Dee），丽贝卡·托德（Rebecca Todd），肯瑞克·Ng。作者和附属机构美国纽约州纽约市纪念斯隆·凯特琳癌症中心放射肿瘤学系Edward Christopher Dee，行为医学中心实践与政策系，伦敦大学学院伦敦药学院，英国丽贝卡·托德（Ukrebcca Todd），佐伊·穆恩（Zoe Moon）和罗伯特·霍恩（Robert Horned）医学肿瘤学系，伦敦巴特斯癌症中心，英国肯瑞克·Ng和乔纳森·沙马（Jonathan Shamash）医学肿瘤学系，英国皇家免费医院NHS基金会信托基金会，伦敦，Ukgolyanne Aidoo Mich纽约，USATroy B。

AmenCase Western Reserve University, University Hospital Urology Institute, Cleveland, OH, USARandy Vince JrDepartment of Radiation Oncology, Kaiser Permanente Northwest, Portland, OR, USAVinayak MuralidharClinical Commissioning Group, NHS North East London, London, UKKatherine MutsvangwaCentre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London.

AmenCase Western Reserve University，俄亥俄州克利夫兰市大学医院泌尿外科研究所，USARandy Vince JR放射肿瘤学系，俄勒冈州波特兰市凯撒永久西北区，USAVinayak MuralidharClinical Commissioning Group，NHS东北伦敦，伦敦，UKKatherine MutsvangwaCentre for Cancer Screening，Prevention and Early Diagnosis，Queen Mary University of London。

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Edward Christopher Dee.Ethics declarations

。道德宣言

Competing interests

相互竞争的利益

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.

K、 N.收到了辉瑞（Pfizer）、葛兰素史克（GSK）和特萨罗（TESARO）、勃林格殷格翰（Boehringer Ingelheim）的个人费用，征服癌症基金会（Converce Cancer Foundation）的旅行补助金以及英国癌症研究所（Cancer research UK）的研究资助。V.M.受雇于西北永久公司（Northwest Perman。B、 上午获得了前列腺癌基金会（PCF）、美国放射肿瘤学会（ASTRO）、国防部和西尔维斯特综合癌症中心的资助。

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.

E、 P.报告称，他们从杨森（Janssen）和默克·夏普（Merck Sharp＆Dohme）获得咨询费，从拜耳（Bayer）获得财务支持，并从安进（Amgen）和阿斯特拉斯（Astellas）获得非财务支持。D、 E.S.在提交的作品之外报告了Janssen、Blue Earth、AstraZeneca和Boston Scientific的个人费用。P.L.N.报告在提交的作品之外收到了拜耳、Janssen和Astellas的赠款和个人费用，以及Boston Scientific、Dendreon、Ferring、COTA、Blue Earth Diagnostics、Myovant Sciences和Augmenix的个人费用。

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.

R、 H.报告阿斯利康，国家健康研究所（NIHR）和英国哮喘研究所（AUKCAR）的资助/研究支持；来自AbbVie，Amgen，Astellas，AstraZeneca，Biogen，Erasmus，Idec，Gilead Sciences，GlaxoSmithKline，Janssen，Merck Sharp Dohme，Novartis，Pfizer，Roche，Shire Pharmaceuticals和TEVA的酬金/咨询费；并且是UCL商业公司（一匙糖）的创始人和股东，该公司为医疗保健政策制定者、提供者和行业提供咨询服务，为患者提供与药物和治疗相关的行为支持。

Z.M. reports paid work for UCL Business Company Spoonful of Sugar. All other authors declare no competing interests..

Z、 M.报告称为UCL商业公司一匙糖有偿工作。所有其他作者声明没有利益冲突。。

Peer review

同行评审

Peer review information

同行评审信息

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.

《自然评论泌尿外科》感谢Clayton Yates，Stefan Ambs，Yaw Nyame和另一位匿名审稿人对这项工作的同行评审做出的贡献。

Additional informationPublisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Related linksCancer Research UK screening for prostate cancer: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/gettingdiagnosed/screeningOur Future Health study: https://ourfuturehealth.org.uk/Prostate Cancer UK risk checker: https://prostatecanceruk.org/risk-checkerRESPOND study: https://www.respondstudy.org/UK Cancer Patient Experience Survey: https://www.ncpes.co.uk/latest-national-results/Rights and permissionsSpringer Nature or its licensor (e.g.

。相关linksCancer Research英国前列腺癌筛查：https://www.cancerresearchuk.org/about-cancer/prostate-cancer/gettingdiagnosed/screeningOur未来健康研究：https://ourfuturehealth.org.uk/Prostate英国癌症风险检查员：https://prostatecanceruk.org/risk-checkerRESPOND研究：https://www.respondstudy.org/UK癌症患者体验调查：https://www.ncpes.co.uk/latest-national-results/Rights和许可证原告性质或其许可人（例如。

a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.Reprints and permissionsAbout this articleCite this articleDee, E.C., Todd, R., Ng, K.

协会或其他合作伙伴）根据与作者或其他权利持有人的出版协议对本文拥有专有权；本文接受稿件版本的作者自行存档仅受此类出版协议和适用法律的条款管辖。转载和许可本文引用本文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..

等。英国和美国前列腺癌的种族差异：相似之处，差异和进步。。

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