Abstract
BACKGROUND: Prostate cancer (PCa) is the most frequent incident cancer among males in industrialized countries, but little is known about its aetiology. A role for occupational exposures is suggested. Occupational exposure as a firefighter, a protective service occupation (PSO), is classified as carcinogenic to humans by the International Agency for Research on Cancer, with limited evidence in humans for PCa. We studied the association between PSO and PCa risk considering tumour aggressiveness and screening practices. METHODS: The EPIdemiological study of Prostate Cancer (EPICAP), the Prostate cancer & Environment Study (PROtEuS) and the MultiCase-Control study in common tumours in Spain (MCC-Spain) are population-based case-control studies, conducted respectively in France, Canada, Spain, in 2005–2014 in men ≤ 85 years old, including overall 3,859 incident cases and 4,359 controls frequency-matched on age. Participants were interviewed face-to-face using general and occupational questionnaires covering all jobs held in career, coded according to the 1988 International Standard Classification of Occupations. Unconditional logistic regressions estimated associations between PSO and PCa, after adjusting for potential confounders. Two sets of analyses were conducted, without and with consideration of screening. The latter is believed to yield the main findings since less subject to detection bias. RESULTS: When restricting controls to those recently screened, men employed as firefighters ≥ 10 years had increased risk (OR (Odds ratio) = 2.01 [95% confidence interval] [1.02; 3.97]) of non-aggressive PCa. Positive associations for non-aggressive PCa among men employed < 10 years as police officers (OR = 2.53 [1.07; 5.96]) and police inspectors and detectives (OR = 6.75 [1.47; 30.96]) were observed. Very few cases in PSO were characterized by aggressive tumours. CONCLUSIONS: Findings from this large population-based study corroborate the higher PCa risk previously reported among firefighters, but only for non-aggressive tumours. Screening practices had a substantial impact on risk estimates. Future studies should investigate specific exposures, and account for PCa aggressiveness and individual screening patterns. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12995-025-00464-7.