As Movember shone a light on men's prostate cancer, screening guidelines for the disease look widely antiquated as modern testing is shunned amid a reduction in the pace of decline of mortality rates.
While awareness comes from the November-long Movember campaign, the reality is another story. Canada's status quo of reflecting U.S. screening recommendations against testing has found overall prostate cancer survival is dropping due to increased cases of metastatic prostate cancer.
A team of scientists led by Dr. Anna Wilkinson, an Associate Professor in the Department of Family Medicine at the University of Ottawa and a GP oncologist at The Ottawa Hospital, with Larry Ellison and Shary Zhang of Statistics Canada, uOttawa researchers Michael Ong, Scott Morgan, Rodney Breau, Christopher Morash, and the University of British Columbia's Larry Goldenberg and Statistics Canada's Larry Ellison and Shary Zhang analyzed nearly 40 years of data to examine prostate cancer trends in Canada.
They found that prostate cancer rates and mortality changed after the arrival of prostate specific antigen (PSA) screening, a blood test that can screen for prostate cancer and find cases earlier when they are more curable and treatments are less intensive. Prostate cancer mortality dropped by over 50% after screening started, with the biggest changes seen among men in their late 50s and 60s. But PSA testing was abandoned in 2012 over concerns of overdiagnosis and subsequent overtreatment.
"We are stuck in a rut where conversations about screening don't take place because we continue to judge the utility of PSA screening based on outdated data and practices," explains study lead Dr. Anna Wilkinson. "Meanwhile, contemporary screening has evolved, incorporating advances like MRI to reduce the need for biopsy, and active surveillance to reduce the need for treatment."
Prostate cancer is the most common cancer in Canadian men (beside non-melanoma skin cancers), accounting for 22 percent of all cancers. It is the third leading cause of cancer death in Canadian men behind only lung and colorectal cancers. Yet after the United States adopted recommendations against screening, the number of stage IV (metastatic/incurable) cancers increased among both younger and older men, rising by about 50% among men 50-74. While significant advances have been made in the treatment of metastatic disease, the rising incidence of stage IV cancers comes at a high personal cost and represents a substantial financial burden for the health care system.
The Canadian Task Force on Preventive Health Care (CTFPHC) has never recommended PSA as a screening tool despite Canadian specialty societies suggesting it for those in good health with a long-life expectancy.
In the absence of organized screening programs, Canadian men need to self-advocate, have a primary care provider order their PSA, and in provinces with no access to screening, pay for their test.
"There are no guardrails to ensure PSA testing occurs at the right ages and frequencies and only those men who can self-advocate, who have a provider, and can afford the test can access it," adds Wilkinson. "The silence surrounding this issue drives inequity and inappropriate use and leads to poor health outcomes."
Instead, we should be considering "contemporary smart screening with a priority placed on optimizing benefits and reducing harms for patients undergoing testing", states Dr. Chris Morash.
The study 'Canadian Prostate Cancer Trends in the Context of PSA Screening Guideline Changes' was published in Current Oncology on December 1, 2025. DOI: 10.3390/curroncol32120669.
