Is it time for Canada to revisit its approach to prostate cancer screening?
review · Level V
Where this comes from
- Record sourced from PubMed, PMID 41040538.
- Also identified by DOI 10.1016/j.lana.2025.101180 and PMC identifier 12485535.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Prostate cancer is the third leading cause of cancer death among Canadian men. Despite advances in the last decade mitigating overdiagnosis and overtreatment, Canadian guidelines have recommended against routine prostate-specific antigen (PSA) screening since 2014. This has resulted in opportunistic screening, marked by inequitable access, low-value testing, and missed opportunities for early detection. We review global policy developments, emerging trial data, and implementation strategies, which suggest that organised, risk-stratified screening may improve outcomes and equity. However, overdiagnosis and associated harms remain a concern within organised programs. To address this uncertainty and generate timely, policy-relevant evidence, we propose implementing population-wide, adaptive platform trials embedded in the healthcare system. This design would enable real-time integration of new technologies, standardised protocols, and equitable access-hallmarks of a learning healthcare system. Such a model could help Canada modernise prostate cancer screening while carefully weighing benefits, harms, and equity in a rapidly evolving landscape.