Prostate cancer is the most common cancer for men in the UK, responsible for the death of one man every 45 minutes. Black men face an even higher risk.

The reasons for prostate cancer more widely impacting black men than any other race are complex, intertwined and varied.

Some reasons black men are more at risk

• Genetics: Black men have higher Gleason scores and higher prostate-specific antigen (PSA) levels than white men, indicating they are at greater risk for more aggressive forms of prostate cancer.
• Racism: Lack of representation in clinical trials and studies combined with a history of ethical malpractice and mistreatment of people of colour have led to a lack of trust. Many black men fear that their PSA screenings may not be thorough enough or their test results may be misused.¹
• Fear and cultural stigma: There can be hesitation among black men to undergo routine screenings, such as a digital rectal exam (DRE) or PSA testing. Concerns about the invasiveness of these procedures and the fear of potential diagnoses contribute to this reluctance.

There is a lack of data in
clinical trials for black patients.

Increasing awareness and trust in prostate cancer health

Although the above factors pose challenges, steps can be taken to dismantle the barriers around prostate cancer care for black men.

• Medical representation: Currently, there is a lack of data in clinical trials for black patients. A large proportion of treatment and diagnostics for prostate cancer has been based on data for white patients, which negatively impacts the healthcare of black patients.² Increasing representation from people of all minority backgrounds in trials will lead to more inclusive and trusted healthcare.
• Early detection: Given the heightened risk and aggressiveness of prostate cancer in black men, early detection and diagnosis are crucial.

The European Association of Urology has been taking steps to combat this stigma. One of the steps involves the development of a patient-reported outcome measures (PROMs) study focused on prostate cancer care for black men of African and Caribbean descent. The other will be the roundtable ‘Championing Black Health Equity in Prostate Cancer,’ which will take place on Patient Day at the Annual EAU Congress in Madrid, 21–24 March 2025.

[1] American Cancer Society, (2022), Racial disparities in Black men with prostate cancer: A literature review, Journal of the American Cancer Society
[2] Prostate Cancer Research, supra

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Ultrasound technology is playing an important role in helping clinicians make critical diagnoses in patients and plan onward treatment strategies.

Tissue biopsies, though invasive and sometimes uncomfortable, are crucial for diagnosing conditions such as prostate cancer and liver or kidney disease. Using ultrasound technology, clinicians can decide on treatment protocols and future therapies based on collected tissue samples.

Modern ultrasound tech for prostate cancer

Improvements to ultrasound are making procedures as comfortable as possible, particularly in areas such as prostate cancer. Simon Jarvis, Segment Lead (urology and surgery) within Fujifilm’s healthcare division, explains that men identified as potentially having prostate cancer from a high prostate-specific antigen (PSA) test reading will be referred by GPs to a consultant for assessment, followed by an MRI scan.

If a lesion is found on review of the MRI scan by a radiologist, the lesion is scored and then the patient would be counselled for the next stage. Potentially, this would be a prostate biopsy performed using an ultrasound-guided probe, typically under local anaesthesia.

Recent advancements, such as a 3mm size reduction in the Fujifilm probe, enhance patient comfort. Later, Crystal technology in the probe enhances image capability; better ergonomics improve the ease of use for theatre staff and help to reduce repetitive strain injury (RSI).

If a lesion is found on review of the MRI scan by a radiologist, the lesion is scored and then the patient would be counselled for the next stage.

Accurate imaging capabilities

Ultrasound provides diagnostic imaging to identify lesions. A positive biopsy for cancer may lead to a further course of treatment.

Jarvis explains: “If you can’t see the lesion, you cannot take a biopsy or guide treatment. It’s also critical that the ultrasound probe is a comfortable size for patients because if you cannot insert the probe, you cannot take a biopsy or get a report back from pathology.”

For difficult-to-locate lesions, fusion technology — such as in the Arietta 65 IntuitiveFusion — combines established ultrasound and MRI diagnostic tools with software to direct urologists to exact targets for prostate biopsies.

Smart identification software

Ultrasound, a non-radioactive imaging modality, also supports the diagnostic pathway in liver and kidney disease with the biopsy needle guided by ultrasound. This is supported by 3D modelling software that links ultrasound and MRI images.

Furthermore, Fujifilm surgical planning software is available to surgeons to navigate the procedure by differentiating between tissue, tubes, vessels, veins and arteries and ensuring surgeons work within safe margins.

“We can use technology on ultrasound to guide incisions,” says Jarvis. “Ultrasound technology can show what is tissue, what is an artery and what is a smaller vessel. We also have similar technology with 3D modelling on open cases, laparoscopically or for robotic surgery.”

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Usually, men aren’t shy when it comes to talking about sex. However, there’s one sexual topic that remains a taboo subject that they would rather forget about completely: erection difficulties (ED).

Ways men experience and deal with erection difficulties

Erection difficulties (or erectile dysfunction) refer to the inability to achieve and/or maintain an erection for satisfactory sexual performance, and it’s more common than you might think. In the UK, one in three men will experience some degree of erection difficulty at some point in their life. It can be a distressing condition and can happen at any age. It occurs when the blood vessels in the penis are narrowed, and the blood flow is not sufficient to get and keep an erection.

Anyone experiencing erection difficulties may feel ashamed and anxious, but generally, the tendency is to pretend it’s not happening. Of 3,445 UK men experiencing ED surveyed, 56% say that sex is a very important part of their relationship, but 63% of them would rather keep their ED issues to themselves.*

Opening up the conversation about erection difficulties

People have to put aside their awkwardness and be more open about ED. Admittedly, it may not be easy. If you’re unable to get or maintain an erection, you might feel extremely uncomfortable discussing it with a healthcare professional. More recently, The Urology Foundation surveyed 2,000 UK men and found that, if they were having ED problems, 46% of them would NOT visit their doctor.

However, the bigger problem is not talking about it at all because of the several misconceptions. Many men — 63% of those surveyed by The Urology Foundation — think that ED is an inevitable consequence of ageing (it isn’t). What’s more, 78% aren’t aware that the condition could be a sign of heart disease. Of course, if you’ve had problems getting a full erection once or twice, it doesn’t necessarily mean you have ED. Still, if you have any concerns, it’s always best to speak with your pharmacist.

Managing the condition with an over-the-counter medicine

Even though some men won’t visit their doctor, there are some positive signs that people would be keen to explore solutions to manage their ED. The Urology Foundation study makes clear that 64% would consider a pill or non-prescription medicine to address the condition.

Also, studies have shown that effective treatment for ED can significantly improve sexual satisfaction for men and their partners and increase sexual self-confidence, resulting in better relationships and an enhanced quality of life.

Cialis® Together is an ED brand available without a prescription at pharmacies, and it is committed to helping men get a fulfilling and healthy sex life. Until recently, the over-the-counter treatments for ED available in the UK have only lasted up to four hours. Cialis® Together is the first non-prescription ED medicine that is effective for up to 36 hours. It works by widening the blood vessels in the penis and will help men get an erection when sexually aroused, and then the erection should subside after sexual activity.

The main advantage of having up to 36 hours to decide when to have sex is that it fits into the realities of a relationship by allowing you to decide when the moment is right for both of you, helping make spontaneous sex an option.

So, don’t be embarrassed. Pharmacists can give you advice about the appropriateness of any medication, its potential side effects and if you need to see your GP. Effective treatment for ED is a beneficial approach. That’s why we need to talk about it more.

Cialis® Together 10mg tablets. For Erectile Dysfunction in adult men. Contains tadalafil. Always read the label.

*Source: Irrational Agency, quantitative survey UK, 2021, N=10,197 adult men; 3,445 men qualified either as suffering erectile dysfunction or identified through IIEF-5 screening (IIEF – International Index of Erectile Function).

MAT-XU-2305654 v1.0 December 2023

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Benign prostatic hyperplasia — or an enlarged prostate — is not cancer, but its symptoms can be severely life-limiting. Thankfully, a safe treatment is available.

The likelihood of developing an enlarged prostate — or benign prostatic hyperplasia (BPH) — increases with age. More than 50% of all men in their sixties and as many as 90% aged between 70 and 89 will have some symptoms of BPH.

Symptoms of benign prostatic hyperplasia

BPH is not cancer and doesn’t raise your risk of developing prostate cancer. However, the symptoms can significantly change the way you live; impacting daily activities, hobbies and sleeping patterns and altering your enjoyment of life.

Normally, the prostate gland is the size of a walnut; but, when it gets bigger, it can compress the urethra (tube where urine passes). The bladder wall then needs to squeeze harder to remove the urine, becoming thicker and irritable; it can begin to contract even when it contains only a small amount of urine.

People with BPH may therefore need to urinate more frequently, especially at night. They may also be unable to urinate; strain while urinating; have a weak urine stream; have a urine stream that starts and stops; experience dribbling at the end of urinating; or be unable to empty their bladder.

PAE is usually performed as an outpatient procedure,
and no general anaesthesia is required.

Prostatic artery embolisation: a safe treatment for BPH

While BPH is common, it shouldn’t be ignored. “Left untreated, it could lead to health complications such as kidney stones, recurrent infections, lack of bladder control and complete bladder outlet obstruction or blockage,” says Clare Bent.

“If your healthcare provider determines that you have benign prostatic hyperplasia, it’s a good idea to discuss the various treatment options available, including prostatic artery embolisation (PAE).” This is a safe treatment option and, like other minimally invasive procedures, has significant advantages over conventional surgical options.

Prostatic artery embolisation process and benefits

With PAE, a tiny incision is made in your groin or wrist to gain access to your arterial system. A catheter is then guided to the vessels that supply blood to your prostate. Embolic material (particles about the size of a grain of sand) is injected through the catheter and into these blood vessels, decreasing blood flow to your prostate. This causes it to shrink, thereby improving urinary symptoms.

“PAE is usually performed as an outpatient procedure, and no general anaesthesia is required,” explains Clare Bent. “During the procedure, you’re given a mild sedative but remain awake. A year after PAE, average prostate size is seen to shrink by approximately 30%, easing urinary symptoms, sparing erectile function and increasing quality of life.”

By ensuring men are aware of all treatment options available, they can make informed and empowered health decisions.

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Mark Rochester

Clinical Director of Urology, Norfolk and Norwich University Hospital

Men are receiving robotically assisted benign prostatic hyperplasia treatment in the UK. The method has been proven to preserve continence and sexual function for patients.

A growing number of men are receiving revolutionary treatment to relieve the debilitating symptoms of enlarged prostates. The procedure utilises robotically assisted surgery and a targeted heat-free waterjet to tackle benign prostatic hyperplasia (BPH), where the prostate gland enlarges and causes difficulty passing urine.

Relieving symptoms caused by benign prostatic hyperplasia

Around 3 million men are affected by BPH, with more than 30,000 a year needing surgery, resulting in a backlog of NHS cases. However, with National Institute for Health and Care Excellence (NICE) recommendation of Aquablation therapy, surgeons are hopeful they can not only cut waiting lists using the technique but also provide better outcomes for patients. It was developed by Procept BioRobotics and available for private and NHS patients.

The procedure takes approximately one hour, has little or no impact on sexual function for men and is normally provided as a day case or one-night stay in the hospital. The treatment, also known as transurethral waterjet ablation, is being made more widely available on the NHS.

Treatment options for benign prostatic hyperplasia

Norfolk and Norwich University Hospital introduced the procedure earlier this year. The hospital’s Clinical Director of Urology, Mr Mark Rochester, says offering a range of treatments remains important as every patient is different in terms of priorities and what they want from the treatments.

One standard treatment for BPH is Trans Urethral Resection of the Prostate (TURP), which is effective in relieving urinary symptoms but can damage parts of the prostate gland essential for sexual function. Other options include a three-hour laser technique known as Holmium Laser Enucleation of Prostate (HoLEP) or using steam or stents to open the prostate to allow passage of urine.

Aquablation therapy surgically removes tissue using a robotically-assisted, heat-free waterjet to resect a channel through the prostate while preserving critical anatomy and sexual function. It’s proving to be a fast and cost-effective option with few side effects.

Rochester says: “After creating the surgical plan, the removal of tissue was robotically executed. It’s efficient use of theatre time, and we’re able to send many patients home the same day.” It can have a positive impact on waiting lists and help reduce NHS backlogs.

With Aquablation therapy, patients notice that
improvement in their waterworks after surgery
is quick, and none have had incontinence,
ejaculatory or erectile complications.

Prof. Nikhil Vasdev

Quicker recovery with fewer side effects

Professor Nikhil Vasdev, Consultant Urological and Robotic Surgeon at Pinehill Hospital in Hitchin, Hertfordshire, has recently started conducting the procedure. He says: “With Aquablation therapy, patients notice that improvement in their waterworks after surgery is quick, and none so far have had incontinence, ejaculatory or erectile complications.

One patient was back at work two weeks after the treatment while another, who had a catheter and could not pass urine, returned to work in four weeks and was catheter-free after 24 hours. “We’re seeing quicker patient recovery compared with traditional treatment, an improvement in outcomes and a reduction in side effects,” adds Professor Vasdev. “That is down to precision of the operation.”

Patients reporting on the outcomes and efficacy

One patient who underwent Aquablation therapy for BPH was retired engineer Surjit Sandhu. He was initially admitted to a hospital in Stevenage where his prostate-specific antigen (PSA) levels were found to be high, and he was placed on intravenous antibiotics before being discharged several days later.

With delays in further investigations, he made an appointment with Professor Vasdev at Pinehill Hospital, where it was confirmed that he had an enlarged prostate. “This was the first time I had medical confirmation that it was BPH and that the growth wasn’t cancerous. This was a huge relief,” says Surjit, 71. After discussing treatment options, the Aquablation therapy procedure was carried out.

“I would recommend this treatment to others who are suffering from an enlarged prostate because the recovery period is less compared to other treatments,” he says. “It’s less invasive and more precise.”

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Prof James Green

Consultant Urologist Barts Health and President of the RSM section of Urology

Testicular torsion is a time-critical medical emergency that can have serious long-term implications if not diagnosed and treated promptly.

Testicular torsion is caused by the twisting of the blood supply of the testis, leading to reduced blood flow. If left for a few hours, the testicle could become unsalvageable despite having surgery.

Criticality of testicular torsion

Delay in presentation to a hospital can result in testicular loss, which can have psychological, fertility and cosmetic consequences for young boys. Studies have found that there are several reasons for delay in receiving treatment for testicular torsion within the critical six hours. Delay over 24 hours has been shown to have a low salvage rate, and even testes that seem salvaged at surgery can still be lost within the year.

Lack of torsion education

One of the main reasons for late presentation is lack of awareness among children, parents and teachers. Education about the condition among these groups is urgently needed to explain the importance of seeking help within one hour of having testicular pain that doesn’t resolve.

Delay in presentation to a hospital can result in testicular loss, which can have psychological, fertility and cosmetic consequences for young boys.

How to improve torsion awareness

The ‘Save the Ball’ group — consisting of Professor James Green, Dr Vicky Stubbs, Miss Caroline MacDonald, Miss Nadine McCauley and Miss Shabnam Undre — has been working to promote awareness of this condition as part of personal, social, health and economic (PSHE) teaching in schools.

Fully tested and validated lesson plans and free online resources have been created in conjunction with teachers and students. The PSHE Association has endorsed this and sent out a letter to all schools in England to draw attention to this important health problem and the teaching resource.

However, uptake is sporadic as there is currently little guidance on what health conditions should be taught, so it is difficult for teachers to know which ones to prioritise. That will hopefully change when the Sex Education and Health Curriculum in Schools is reviewed shortly and teaching about torsion is formalised across the whole country.

Prioritising testicular health

Testicular health (torsion and testicular self-examination to diagnose cancer) will hopefully be chosen as highly relevant subjects to teach. Over time, we hope to see a shift in the public’s understanding of testicular torsion; recognition of symptoms; and what action to take. More children will then present earlier to a hospital and reduce the unnecessary loss of testicles that currently occurs, which is preventable. The line ‘I wish I’d known as I would have come sooner and saved my testicle’ can become a thing of the past.

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In the UK, 12.5% of men suffer from common mental health disorders. The statistics are a stark reminder of the importance of improving men’s access to mental health services.

About 76% of suicides in the country are committed by men, making it the leading cause of death for men under 35. Despite greater national focus on ensuring good mental health, men still struggle to access mental health services in the UK.

Why men avoid seeking health support

Mental health has long been stigmatised, and men often encounter hurdles when they seek assistance. Health conditions that disproportionately affect men — such as prostate cancer, incontinence and urological disorders — can intensify these obstacles.

The emotional and physical burden of these conditions often leads to feelings of shame and a perceived loss of masculinity. Consequently, men often downplay their mental health struggles and avoid seeking help.

Improving access to health for all

We must urgently challenge the stigmas surrounding men’s mental health and improve access to support. Access to mental health services can be even more challenging for Black men. Black British men are four times more likely to be detained under the Mental Health Act than their white counterparts.

Once detained, Black men are often subjected to restraint and are more likely to be detained in high-security wards. This takes a significant toll on health, education and social interactions.

We must also challenge the common misconception that Black African Caribbean men are ‘harder to reach.’ Instead, we must ensure that services become more accessible to Black men by providing safe spaces and working with Black communities.

Black British men are four times more likely to be detained under the Mental Health Act than their white counterparts.

Mental health policy landscape

The Mental Health Act, which has been in place for over 40 years, requires reform to bring it in line with the demands of the 21st century. However, the shelving of the Mental Health Bill in the recent King’s speech means that the legislation to reform the Act will not pass before the next general election. Failure to reform the Act in this Parliament is likely to come at a significant human cost.

Equitable mental health policies

Policy Connect and Manchester Metropolitan University have been working on the NIHR-funded project called ImprovE-ACT. This research, conducted alongside lived experience co-investigators, aims to investigate the experiences of Black men in the UK detained under the Mental Health Act.

Together, we will set out critical policy recommendations to urgently reform the Mental Health Act on a national level. Addressing the disparities in men’s mental health and improving access to services is a multifaceted challenge that requires collective action, policy change and challenging societal norms.

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Around 15% of couples do not achieve pregnancy within one year. Infertility is when a sexually active, non-contracepting couple does not achieve spontaneous pregnancy within one year.

Although 50% of infertility is associated with a male factor, investigation and treatment of men often remain rare as an initial step in the journey of a couple wishing to seek infertility treatment.

Key male infertility terms

The World Health Organization (WHO) has standardised semen parameters, which often prompt investigation in men.

• Azoospermia is the absence of sperm in the ejaculate and can be found in 10% to 15% of men with infertility.
• Oligospermia is too few sperm in the ejaculate (less than 15 million/ml).
• Asthenospermia is a reduction in sperm motility.
• Teratospermia is the abnormal structure of sperm (<4% normal).

Treatment varies from improving lifestyle
choices to procedural interventions.

Common causes of male factor infertility

• Lifestyle factors
  • Use of steroids and testosterone supplements
  • Smoking, excess alcohol intake, recreational drug use (eg. cannabis)
• Hormonal imbalance, including low testosterone
• Excess heat exposure to the scrotum and testicles (eg. laptops, hot baths)
• Previous trauma/surgery to the testicle or groin
• Cancer or cancer treatment
• Infections, including sexually transmitted infections or mumps affecting the testicle

• Sexual dysfunction: inability to develop an erection, orgasm and ejaculate
• Structural abnormalities; some of which the patient may have from birth and others that may be acquired (eg. varicocele enlarged veins in the scrotum, which raises temperature)
• Genetic abnormalities, such as those causing cystic fibrosis and Klinefelter’s syndrome

Assessment of men with infertility

This should ideally be done by a men’s health specialist (urologist). It involves a thorough history and examination of the patient to explore what the underlying cause may be. This also provides an opportunity to treat reversible causes like reducing alcohol and stopping smoking. It is highly recommended that all men have a semen analysis, testicular scan and hormonal blood tests as well.

Infertility treatment options

Treatment varies from improving lifestyle choices to procedural interventions like varicocele corrections in men with too few sperm. For men with no sperm in their ejaculate, once all other aspects have been optimised, there is often the chance of surgical sperm retrieval. This can be achieved through a variety of techniques, including microsurgical retrieval in specialist units.

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Patient voices are leading the way to better continence care in Europe. Momentum is building and patients are demanding policy change and institutional support.

Incontinence is a pervasive issue with a heavy physical and psychosocial toll on patients and their loved ones. Incontinence is also connected to higher rates of anxiety and depression.

Support for patients with incontinence

The stigma and taboo around incontinence only exacerbates the issue, causing many patients to ignore symptoms or delay diagnosis, particularly in men who hesitate to seek help with their continence health. Support for patients living with incontinence should be forthright and readily available. 

EU Continence Health Summit

A new multistakeholder campaign, An Urge to Act, seeks to take strong policy action towards achieving this support. In a huge step forward, on 8 November 2023, the EU Parliament hosted the first EU Continence Health Summit in Brussels.

The summit, as a first step of the Urge to Act campaign, is focused on policy reform in the EU to support those living with incontinence. The manifesto released at the Summit addresses the current impact of incontinence — not only the personal impact on the 55–60 million Europeans who suffer from continence health problems but also the larger economic impact for society.

Incontinence costs European society
over 40 million euros per year.

Cost of incontinence in Europe

In collaboration with the EAU’s Urology Week, some of the findings by the Urge to Act campaign were shared, including the alarming number that incontinence costs European society over 40 million euros per year. Without action, this number is expected to increase, furthering the economic and environmental burden of incontinence.

The manifesto calls for swift and strong policy action to tangibly improve continence care in Europe. By identifying 10 key points, it advocates for a systemic response to incontinence care, calling for equitable access to facilities and care, better patient education outreach and funding for the research of healthy and sustainable solutions. The manifesto is a huge step forward in patient-centric solutions in continence health.

Continence health is driven by patients

The patient voice is a key driver in shaping the future of continence care. The risk of continence problems often correlates with conditions that develop or intensify as people age; as Europe ages, that number is only expected to rise.

Patient advocacy groups and dedicated patient resources like the European Association of Urology’s Patient Office continue to amplify the patient voice and drive change through collaboration, empowerment and action. The Urge to Act campaign is a much-needed step in growing the movement towards patient-centric care.

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Five-day prostate cancer treatment is available using smart technology, which enables men to return to their normal lives quickly, with peace of mind.

The MRIdian SMART technology is an exciting step in treating a disease affecting more than 52,000 men each year. Prostate cancer, caught at an early stage before it’s spread, has a good outlook.

Benefits of five-day radiotherapy

Surgery or radiotherapy are equally effective in treating prostate cancer, but both treatments have side effects, and you also need to factor in the length of treatment and recovery time. Recent advances in radiotherapy technology now provide men with treatment, which minimises side effects and is completed in just five days — enabling a quick return to normal life. A recent study also reported that five-day treatment delivered similar prostate cancer control when compared with standard radiotherapy.

Real-time tumour tracking

Treatment is done using Stereotactic Ablative Radiotherapy (SABR or SBRT) — a modern treatment for localised prostate cancer. We use a machine called the MRIdian MR linac, which has a built-in MRI scanner to track the tumour and view the area being treated on a live feed, allowing us to accurately target radiation at the prostate.

This advanced technology protects
the bladder and bowel. No other
radiotherapy machine has this capability.

Targeted radiotherapy reduces side effects

Standard radiotherapy might cause long-term side effects, as the bladder and bowel sit close to the prostate. During treatment, radiation can also reach these areas due to normal body movements, which can lead to more noticeable urinary and bowel side effects.

However, using MRIdian MR linac radiotherapy, we can see and adjust the radiotherapy target throughout treatment. If the tumour moves out of range, the radiotherapy beam automatically switches off. This advanced technology protects the bladder and bowel. No other radiotherapy machine has this capability.

The ability to see the tumour means we can give higher doses of radiotherapy over just five consecutive days, compared to the standard 20–39 days of a smaller daily dose of radiotherapy. The overall dose given is the same in both types of treatment.

We’re also so confident in the accuracy, men who’ve already received radiotherapy to the prostate can return in the future, known as prostate cancer reirradiation.

Fast return to everyday life

You can start on a Monday, and by the weekend, treatment is complete. Many men receiving this treatment experience minimal impact on their lives; they’re able to continue working or even play sports without any long-term side effects.

Five-day treatment for prostate cancer is available on the MRIdian MR linac at GenesisCare centres in Oxford and Cromwell Hospital in London. Patients can use their private medical insurance or pay for themselves.

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