Canadian Prostate Cancer Trends in the Context of PSA Screening Guideline Changes

Prostate cancer is the most diagnosed cancer among Canadian men, except non-melanoma skin cancers. Prostate-specific antigen (PSA) screening can enable early detection, but it is not formally recommended in Canada. Nonetheless, opportunistic screening persists, influenced by US practices and some Canadian guidelines that support screening. This study provides a detailed analysis of trends in prostate cancer incidence, mortality, stage distribution, and net survival in the context of evolving PSA screening guidelines. Prostate cancer case (1984-2022) and death (1984-2023) data were primarily from the Canadian Cancer Registry and the Canadian Vital Statistics Death database, respectively. Joinpoint regression identified incidence and mortality trends. Net survival was determined using the Pohar Perme estimator. Following the introduction of PSA screening, the prostate cancer age-standardized incidence rate among men aged 50-74 increased 1.8% annually until 2007 (<i>p</i> = 0.006) before declining at an annualized rate of -5.9% (<i>p</i> = 0.005) until 2014. Among men aged ≥75, incidence declined at -3.2% annually from 1992 to 2015 (<i>p</i> < 0.001). The prostate cancer age-standardized mortality rate (ASMR) among men aged 50-74 fell at an annualized rate of -4.3% between 1994 and 2010 (<i>p</i> = 0.022), but the decline slowed thereafter. The ASMR among men aged ≥75 continuously declined after a peak in 1995, with the greatest change noted before 2012. From 2010 to 2017, stage IV prostate cancer incidence increased across all 10-year age groups, peaking among men aged 60-69 at 4.1% annually (<i>p</i> < 0.001). Among men aged 50-74, the corresponding annualized increase was 3.7% (<i>p</i> = 0.010), while among men aged ≥75, it was 3.1% (<i>p</i> < 0.001). Although stage IV net survival among men aged 50-74 increased from 49.4% in 2010-2011 to 56.6% in 2016-2017, all-stage net survival declined slightly after 2011, concurrent with a shift towards a greater proportion of stage IV cases. Prostate cancer outcomes in Canada reflect US PSA screening recommendations. Organized and thoughtful screening may represent an opportunity to decrease the rising late-stage incidence.