Disparities in prostate cancer outcomes between First Nations and Non-First Nations men in Canada-Cohort study.

Abstract

First Nations men in Canada, one of the three distinct Indigenous groups along with Inuit and Métis, have been reported to present with more aggressive prostate cancers than non-First Nations men. However, the long-term impact on prostate cancer-specific survival remains unclear. This study examines disparities in prostate cancer outcomes between First Nations and non-First Nations men in Alberta. Data from the Alberta Cancer Registry (1995-2022) were analyzed for all men aged 18 and above diagnosed with prostate cancer. First Nations status was determined using the Alberta Health Care Insurance Plan registry. The primary outcome was age-standardized prostate cancer mortality; secondary outcomes included age at death and prostate cancer-specific survival. Statistical analyses included t-tests, Chi-squared tests, Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards models. Data on socioeconomic deprivation were not available, and analyses could not be adjusted for this potential confounder. The dataset comprised 1,323,333 person-years for First Nations men and 37,820,148 for non-First Nations men. First Nations men were diagnosed younger (65.8 vs. 67.8 years, p < 0.0001) and died earlier (74.4 vs. 78.9 years, p < 0.0001) across both rural and urban settings. Age-adjusted prostate cancer mortality was higher (41.5 vs. 30.1 per 100,000, p < 0.0001), and Stage IV disease was more common (17.8% vs. 12.2%, p < 0.0001). Prostate cancer-specific survival was worse (HR 1.67, 95% CI 1.43-1.96, p < 0.0001). After adjusting for age, stage, location, and number of malignancies, overall survival was similar (HR 1.06, 95% CI 0.57-1.89, p = 0.84). First Nations men in Alberta are diagnosed with prostate cancer at a younger age and later stage, leading to higher overall mortality. After adjustment, disease-specific survival is similar to non-First Nations men. These findings indicate disparities may arise from delayed diagnosis, underscoring the need for culturally safe, community-informed initiatives promoting earlier presentation and detection. Movember, Alberta Cancer Foundation, Bird Dogs, University Hospital Foundation.