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

Sep 23, 2026

Prostate cancer is the most diagnosed cancer among Canadian men, excluding non-melanoma skin cancers. PSA screening can support early detection, yet it is not formally recommended in Canada; opportunistic screening continues, shaped by US practices and some Canadian guidance. This study analyzes prostate cancer incidence, mortality, stage distribution, and net survival from 1984–2022/2023 using registry and vital statistics data, with Joinpoint regression and Pohar Perme net survival estimation. Results link PSA-era guideline shifts to earlier diagnosis, falling mortality, rising stage IV incidence, and changing survival outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

Simple Summary

Abstract

Introduction

Methods

Incidence and mortality data sources

Statistical analyses (Joinpoint, net survival)

Results

Incidence and mortality trends

Stage distribution and stage IV changes

Net survival patterns

Discussion

Conclusions

Article Canadian Prostate Cancer Trends in the Context of PSA Screening Guideline Changes Anna N. Wilkinson 1, *, Larry F. Ellison 2, Shary X. Zhang 2, Michael Ong 3, Scott C. Morgan 4, S. Larry Goldenberg 5, Rodney H. Breau 6 and Christopher Morash 6 Received: 2 October 2025 Revised: 18 November 2025 Accepted: 25 November 2025 Published: 29 November 2025 Citation: Wilkinson, A.N.; Ellison, L.F.; Zhang, S.X.; Ong, M.; Morgan, S.C.; Goldenberg, S.L.; Breau, R.H.; Morash, C. Canadian Prostate Cancer Trends in the Context of PSA Screening Guideline Changes. Curr. Oncol. 2025, 32, 669. [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.3390/curroncol32120669](10.3390/curroncol32120669) Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) . 1 Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada 2 Centre for Population Health Data at Statistics Canada, Government of Canada, Ottawa, ON K1A 0T6, Canada; larry.ellison@statcan.gc.ca (L.F.E.); sharyxinyu.zhang@statcan.gc.ca (S.X.Z.) 3 Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada; [mong@toh.ca](mong@toh.ca) 4 Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON K1H 8L6, Canada; [smorgan@toh.ca](smorgan@toh.ca) 5 Department of Urologic Sciences and the Vancouver Prostate Centre, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; [l.gold@ubc.ca](l.gold@ubc.ca) 6 Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada; [rbreau@toh.ca](rbreau@toh.ca) (R.H.B.) * Correspondence: [anwilkinson@toh.ca](anwilkinson@toh.ca) Simple Summary Prostate cancer trends in Canada were associated with US PSA screening recommendations. After prostate cancer screening became widespread, cases increased rapidly in younger men and began decreasing among men aged 75 and older. Prostate cancer in Canada changed after the introduction of PSA screening, shifting the initial diagnosis to an earlier age. Prostate cancer mortality dropped by over 50% after screening started, with the biggest changes seen among men in their late 50s and 60s. After US recommendations against screening, mortality reductions lessened, and the number of early-stage cases decreased, while stage IV (metastatic/incurable) cancers increased among both younger and older men. Multiple new life-prolonging treatments for patients with metastatic disease have increased the survival for stage IV cancer. However, overall survival decreased from when screening was recommended, attributable to the increased number of incurable cases. Abstract 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 (p = 0.006) before decli

FAQs

How did PSA screening guideline changes relate to prostate cancer trends in Canada?

After widespread PSA screening, incidence rose rapidly in younger men and decreased among men aged 75 and older, while mortality dropped by over 50%. Following US recommendations against screening, mortality reductions lessened and early-stage cases decreased, with stage IV cancers increasing.

What data sources were used for incidence and death outcomes?

Prostate cancer case data (1984–2022) came primarily from the Canadian Cancer Registry, and death data (1984–2023) came primarily from the Canadian Vital Statistics Death database.

What statistical methods supported the trend and survival findings?

Joinpoint regression was used to identify incidence and mortality trends, and net survival was estimated using the Pohar Perme estimator.

Sep 23, 2026

Uploaded by RuangKosong