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Black men in England have three times the age-adjusted incidence of diagnosed prostate cancer as compared with their White counterparts. This population-based retrospective cohort study is the first UK-based investigation of whether access to diagnostic services underlies the association between race and prostate cancer. Prostate cancer was ascertained using multiple sources including hospital records. Race and factors that may influence prostate cancer diagnosis were assessed by questionnaire and hospital records review. We found that Black men were diagnosed an average of 5.1 years younger as compared with White men (Po0.001). Men of both races were comparable in their knowledge of prostate cancer, in the delays reported before presentation, and in their experience of co-morbidity and symptoms. Black men were more likely to be referred for diagnostic investigation by a hospital department (P ¼ 0.013), although general practitioners referred the large majority of men. Prostate-specific antigen levels were comparable at diagnosis, although Black men had higher levels when compared with same-age White men (Po0.001). In conclusion, we found no evidence of Black men having poorer access to diagnostic services. Differences in the run-up to diagnosis are modest and seem insufficient to explain the higher rate of prostate cancer diagnosis in Black men. Radical treatment can cure localised prostate cancer, but can lead to serious side effects, and many untreated men do not develop advanced disease (Albertsen et al, 2005). Risk factors and prognostic factors are needed to identify those men with an increased chance of developing cancer and of seeing that cancer progress, as these men have a more favourable balance of risks and benefits when undergoing screening tests and radical treatment. Black race is one of very few factors supported by convincing evidence (Gronberg, 2003). Surveillance, Epidemiology, and End Results (SEER) data from the United States indicate that Black men are 2.4 times more likely to die of prostate cancer than White men of the same age (US Cancer Statistics Working Group, 2005). In England, where prostate-specific antigen (PSA)-based screening is uncommon, the PRostate Cancer in Ethnic SubgroupS (PROCESS) study has demonstrated Black men to have 3.1 times the incidence of prostate cancer as compared with their same-age White counterparts . Black men also have a poorer prognosis than similar age White men. A meta-analysis of US data found the disease-specific case-fatality rate to be 29% higher . The higher rate of prostate cancer in Black men may arise from a genuinely higher incidence, or alternatively there may be an equal incidence of prostate cancer but a greater likelihood of diagnosis among Black men. US studies suggest that Black men have worse access to health care generally (Institute of Medicine, 2001), and may have poorer access to PSA testing in particular (Freedland and Isaacs, 2005), although a recent study has found Black men aged 40 -49 years to be subject to a higher rate of test...

IntroductionSpontaneous bladder rupture is a rare and serious event with high mortality. It is not often considered in the patient presenting with peritonitis. This often leads to delays in diagnosis. There are very few case reports of true spontaneous rupture in the literature. This is the first such reported case in which bladder rupture was attributable to neurogenic bladder dysfunction following a stroke.Case presentationWe report the case of a 67-year-old Caucasian man who presented with lower abdominal pain and a peritonitic abdomen. He had a long-term urethral catheter because of urinary retention following a previous stroke. He was treated conservatively with antibiotics before a surgical opinion was sought. Exploratory laparotomy confirmed the diagnosis of spontaneous bladder rupture. After repair of the defect, he eventually made a full recovery.ConclusionIn this unusual case report, we describe an example of a serious event in which delays in diagnosis may lead to increased morbidity and mortality. To date, no unifying theory explaining why rupture occurs has been postulated. We conducted a thorough literature search to examine the etiological factors in other published cases. These etiological factors either increase intra-vesical pressure or decrease the strength of the bladder wall. We hope that by increasing awareness of these etiological factors, spontaneous bladder rupture may be diagnosed earlier and appropriate therapy started.

BACKGROUND: In the United States, Black men have a higher risk of prostate cancer and worse survival than do White men, but it is unclear whether this is because of differences in diagnosis and management. We re-examined these differences in the United Kingdom, where health care is free and unlikely to vary by socioeconomic status. METHODS: This study is a population-based retrospective cohort study of men diagnosed with prostate cancer with data on ethnicity, prognostic factors, and clinical care. A Delphi panel considered the appropriateness of investigations and treatments received. RESULTS: At diagnosis, Black men had similar clinical stage and Gleason scores but higher age-adjusted prostate-specific antigen levels (geometric mean ratio 1.41, 95% confidence interval (95% CI): 1.15 -1.73). Black men underwent more investigations and were more likely to undergo radical treatment, although this was largely explained by their younger age. Even after age adjustment, Black men were more likely to undergo a bone scan (odds ratio 1.37, 95% CI: 1.05 -1.80). The Delphi analysis did not suggest differential management by ethnicity. CONCLUSIONS: This UK-based study comparing Black men with White men found no evidence of differences in disease characteristics at the time of prostate cancer diagnosis, nor of under-investigation or under-treatment in Black men.