Background Prostate cancer is the second most common cancer in men. Ethnic differences in incidence have been studied, suggesting highest rates in Black men and lowest in Asian ethnic groups, but a systematic review has not been conducted. Ethnic differences in incidence of prostate cancer between White, South Asian, Black and Chinese men from the year 2000 onwards were systematically reviewed.

Methods MEDLINE (1946–25^th June 2014), EMBASE (1946–25^th June 2014) and In Process MEDLINE databases were searched to identify relevant studies, supplemented by reference lists and citations of included studies. Population based original research studies comparing incidence of prostate cancer between two or more of the ethnic groups in question (Black, White, South Asian and Chinese) in the same country were included, provided they had been published after 2000. Papers were quality assessed using the STROBE checklist and data were extracted.

Results 23 articles were included. 22 of 23 studies comparing Black and White men described increased incidence of prostate cancer in Black men (risk ratios 1.47–2.39). South Asians had lower rates than White men in 7 of 8 studies (risk ratios 0.29–1.41) while incidence in Chinese men was consistently lower than in White men in all 5 studies (risk ratios 0.48–0.85).

Conclusion Our review confirmed that prostate cancer is most common in Black men. Chinese and South Asian groups had low incidence. These variations may influence screening protocols. Further investigation of the causal basis for these variations would be valuable.