Background: In Blacks, late presentation, lack of knowledge, health infrastructural deficiencies and socio-demographic characteristics, which result in poor outcomes, are the bane of cancers. This study evaluated health access and lifestyle association with prostate cancer (PCa) knowledge and screening among black men.

Methodology: This study used data from the Prostate Cancer Transatlantic Consortium familial cohort study. Data were gathered from a cross-sectional survey of 500 community-dwelling black men in Nigeria, Cameroon, and the USA. Information on socio-demographics, health care access, PCa knowledge score and screening behaviour was obtained, and the association between these variables was evaluated.

Results: The majority (81.6%) were Nigerian. The age ranges were 35–49 (55.2%) and ≥65 (8.4%). The income distribution of the respondents showed that 23.3% earned <$1,000 and 30.7% (>$2,000) monthly. Only 43% had health insurance coverage, and 12% had accessed a doctor in 12 months. Respondents relied on orthodox medicine (50.8%), neighbourhood pharmacy (10.6%), self-medication (5%) and neighbourhood nurse (24.6%). The participants had either poor (45.2%) or very poor (23.2%) dietary patterns. Most (66.67%) do not engage in physical activity and about 33.33% engage in some exercises. Moreover, 87.8% and 78.3% have never had a digital rectal examination (DRE) and prostate-specific antigen (PSA) screening in their lifetime, respectively, while 6.8% and 1.6% had DRE last 1 year and 2 years, respectively. Furthermore, 65.2%, 19.8% and 15% of the respondents had poor, fair and good knowledge of PCa, respectively. Health care coverage (p < 0.001), medical care habit (p = 0.001), routine checkup (p = 0.013) were significantly associated with respondents’ PCa knowledge. Routine checkup (p < 0.001) and country (p < 0.001) were significantly related to PSA screening.

Conclusion: The study showed that PCa screening uptake was poor among the respondents and country of residence was associated with PCa screening behaviours. Healthcare coverage was significantly associated with PCa knowledge.