Cancer is now the leading cause of line-of-duty death among Canadian firefighters. While lung, colorectal, and skin cancers often dominate the conversation, prostate cancer deserves equal attention. It is the most commonly diagnosed cancer among Canadian men (excluding non-melanoma skin cancers) and the third leading cause of cancer death.

For firefighters, who face unique occupational exposures, prostate cancer is not just a population-level issue — it is a workplace hazard with direct implications for health, compensation, and survivorship. There is limited evidence that firefighting causes prostate cancer, and increased prostate cancer mortality has been found to be  associated with more years as a firefighter (Teras et al, 2025).

Recent Canadian research provides new insights into prostate cancer trends in the context of PSA (prostate-specific antigen) screening guideline changes (Wilkinson et al., 2025). These findings carry important lessons for the fire service, particularly as firefighters continue to advocate for presumptive coverage, equitable access to screening, and occupational health protections.

Why prostate cancer matters for firefighters

Occupational exposure: Firefighters are regularly exposed to carcinogens such as polycyclic aromatic hydrocarbons, diesel exhaust, benzene, and flame retardants. These exposures are cumulative, occurring over decades of service. Research has linked them to elevated risks of multiple cancers, including prostate cancer. Unlike the general population, firefighters cannot avoid these exposures — they are inherent to the job.

Presumptive coverage: Several provinces include prostate cancer in presumptive legislation for firefighter occupational disease claims. However, eligibility often depends on years of service and age at diagnosis. This creates gaps: younger firefighters diagnosed early may not qualify, while retirees may face challenges proving occupational causation.

Equity in detection: Our national guidelines recommend against prostate cancer screening, and so, access to PSA screening is inconsistent across Canada. In Ontario, British Columbia, and Quebec, men often must pay out-of-pocket unless a physician orders the test. For firefighters in smaller or rural departments, barriers to timely screening are compounded by limited healthcare access. This inequity undermines occupational justice.

Key findings from Canadian prostate cancer trends

This study used 40 years of national cancer data to investigate the impacts of prostate cancer screening guideline changes on prostate cancer outcomes. It included over half a million prostate cancer cases and almost 150,000 prostate cancer deaths. Prostate cancer screening has never been recommended in Canada, but changes in Canadian cases were clearly linked to US guideline changes.

The key findings of this study were:

• After screening became widespread, prostate cancer diagnosis shifted to an earlier age.
• Cases increased rapidly in younger men and decreased among men 75 and older
• 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 stage IV or incurable cases increased among both younger and older men
• The rate of Stage IV cancer at diagnosis increased by about 50% among men 50-74
• Multiple new life prolonging treatments for patients which have increased survival in stage IV cancer
• However, the overall survival for prostate cancer is lower now than it was 20 years ago with the increasing number of incurable stage IV cases

These findings suggest that screening was finding clinically relevant cases in younger men.

 Firefighter relevance:

• Many Canadian firefighters in their peak service years fall into the age bracket where the highest morality benefit from screening was noted. Early detection could prevent advanced disease and preserve both life expectancy and quality of life.
• For a profession already at elevated cancer risk, reduced screening uptake can mean more late-stage diagnoses. This undermines presumptive coverage frameworks, which often rely on early detection to establish occupational causation.
• Many retirees are diagnosed after leaving the service. Earlier detection during active duty could reduce the burden of advanced disease in retirement, improving both health outcomes and pension sustainability.
• While treatment advances are critical, prevention and early detection remain the most cost-effective strategies. For firefighters, this means advocating for accessible PSA screening as part of occupational health programs

Prostate cancer screening has evolved

Although PSA is not a perfect test, great strides have been made to improve its use. Abnormal PSA tests are now routinely repeated before biopsy, and risk assessment with MRI is used to determine the need for biopsy. Diagnosis and treatment have been uncoupled, with the use of “active surveillance” for low-risk cases, which are monitored and only treated if necessary.

Lessons for the fire service

Screening as prevention, not just detection: Firefighters understand prevention better than most. Just as smoke alarms and sprinklers save lives by acting early, PSA screening saves lives by catching cancer before it spreads. The analogy is clear: early detection is the fire alarm of cancer prevention.

Stage IV disease as the “Fully Involved Fire”: The rise in stage IV prostate cancer after screening guidelines changed is akin to arriving at a structure fire already fully involved. At that point, suppression is possible, but damage is inevitable. Screening shifts the timeline, allowing intervention when the “fire” is still contained.

Equity and access: Currently, PSA screening in Canada is inconsistently applied. For firefighters, this creates inequities: those with strong union support or urban healthcare access may get screened, while others may not. This undermines health equity and occupational justice.

Policy and advocacy implications

1. Presumptive Coverage Alignment
   Prostate cancer is included in presumptive coverage in several provinces, but eligibility criteria vary. Aligning presumptive frameworks with the latest epidemiological evidence would strengthen firefighter protections. For example, recognizing the mortality benefits of screening in men aged 55–59 could justify lowering service-year thresholds.
2. Occupational Health Programs
   Fire departments should integrate PSA screening into annual occupational health checks, particularly for men aged 50–69. This would reduce reliance on self-advocacy and ensure equitable access across the service.
3. Equity Lens
   Disparities in prostate cancer outcomes by race are well-documented. For Indigenous and racialized firefighters, barriers to screening compound occupational risks. National firefighter health strategies should address these inequities.
4. Integration with Innovations
   Active surveillance and MRI-guided biopsy are reducing overdiagnosis and overtreatment. Firefighter health programs should incorporate these innovations, balancing early detection with quality-of-life considerations.

Considerations for the Canadian firefighter community

• Integrate screening into occupational health protocols, ensuring annual access for men aged 50–69.
• Educate members on the importance of early detection, using fire service analogies to make the case relatable.
• Address equity gaps, ensuring Indigenous and racialized firefighters have equal access to screening and follow-up care.
• Track outcomes through firefighter cancer registries, linking screening uptake to incidence and mortality trends.
• Strengthen union advocacy, ensuring PSA screening is recognized as a core occupational health right.
• Promote survivorship programs, supporting firefighters diagnosed with prostate cancer through treatment, recovery, and return to duty.

For Canadian firefighters, prostate cancer is not just a medical issue — it is an occupational hazard shaped by policy, equity, and advocacy. The evidence is clear: PSA screening reduced mortality, particularly among men in their 50s and 60s. When screening declined, stage IV diagnoses rose, and survival gains plateaued or even dropped despite treatment advances.

The fire service knows the value of prevention. Just as alarms and suppression systems save lives, screening saves lives. By advocating for accessible PSA testing, integrating it into occupational health programs, and addressing equity gaps, the Canadian firefighter community can lead the way in reducing prostate cancer mortality.

Cancer prevention is fire prevention. For firefighters, the fight against prostate cancer is a fight for their lives, their families, and the future of the service.

Len Garis is a retired fire chief for the City of Surrey, B.C., associate scientist emeritus with the B.C. Injury Research and Prevention Unit, and research associate with the Community Health and Social Innovations Hub, University of the Fraser Valley. Contact: lwgaris@outlook.com

Anna Wilkinson is a family physician and GP oncologist at the Ottawa Hospital. She is an associate professor in the Department of Family Medicine at the University of Ottawa, program director for the PGY-3 FP Oncology program and regional cancer primary care lead. Contact: anwilkinson@toh.ca

References

https://www.canada.ca/en/health-canada/services/environmental-workplace-health/firefighters-health/national-framework-cancers-linked-firefighting.html

Teras, L. R., Diver, W. R., Mitchell, E. L., Hodge, J. M., Turner, M. C., Deubler, E. L., Smith, R. A., Knudsen, K. E., Dahut, W. L., & Patel, A. V. (2025). Occupation as a firefighter and cancer mortality in a population-based cohort in the United States. International journal of epidemiology, 54(4), dyaf104. https://doi.org/10.1093/ije/dyaf104

Wilkinson AN, Ellison LF, Zhang SX, Ong M, Morgan SC, Goldenberg SL, Breau RH, Morash C. Canadian Prostate Cancer Trends in the Context of PSA Screening Guideline Changes. Current Oncology. 2025; 32(12):669. https://doi.org/10.3390/curroncol32120669