Trends in prostate cancer incidence and mortality in Canada during the era of prostate-specific antigen screening

©2016 8872147 Canada Inc. or its licensors CMAJ OPEN, 4(1) E73 Prostate cancer is the most commonly diagnosed non–skin cancer among Canadian men, with an about 1 in 8 lifetime risk of being diagnosed.1 Initial detection now occurs commonly from prostate specific antigen (PSA) screening. The PSA test was introduced in 1986,2 initially for diagnosis and follow-up, then used in Canada and the United States for screening from the early 1990s.3,4 Subsequently, there was a dramatic increase in the apparent incidence5 of the disease, so that by 2008 these countries had prostate cancer incidence rates among the highest worldwide.6 During the same period, mortality from prostate cancer has been decreasing. Advocates assert that PSA screening has allowed earlier diagnosis and treatment, which in turn led to the reductions in mortality.7–9 We sought to describe secular changes in the Canadian epidemiology of prostate cancer. In particular, we examine the relation between the onset of PSA screening, prostate cancer incidence and mortality.