Introduction Meta-analyses have shown firefighters to have increased prostate cancer (PCa) incidence compared to the general population. Firefighters are exposed to many occupational carcinogens, but no chemical agent is considered an established risk factor for PCa. Increased diagnostic intensity through regular health check-ups has been suggested as an explanation for increased PCa risk among firefighters.

Objectives To examine age at diagnosis, prognostic factors and survival of PCa in Norwegian firefighters and three other occupations undergoing occupational health check-ups, and comparing with PCa cases in the general population.

Methods All PCa cases diagnosed 1960–2017 were extracted from the Cancer Registry of Norway. Firefighters, military employees, pilots and police officers were identified through occupational data from Statistics Norway. Age at diagnosis, clinical stage, prostate-specific antigen (PSA), Gleason score, performance status and overall and PCa-specific survival in cases in these occupations were compared with cases in the general population.

Results Firefighters were significantly younger at PCa diagnosis than cases in the general population in the periods 1960–1993 (mean difference 2.1 years) and 2007–2017 (mean difference 4.3 years). At diagnosis, firefighters had significantly lower PSA values, Gleason scores and performance status scores than the general population. Firefighters diagnosed 2007–2017 had lower risk of all-cause death compared to the general population (crude hazard ratio (HR) 0.71 (0.53–0.95)). No difference was found after adjusting for age at diagnosis (HR 1.03 (0.77–1.37)). Cases in the other three occupations generally also had lower age at diagnosis, better prognostic factors and better crude overall survival than cases in the general population.

Conclusion Younger age and better prognostic factors at PCa diagnosis among firefighters and other occupations with requirements for health check-ups compared with cases in the general population may indicate an increased diagnostic intensity, likely contributing to elevated PCa incidence in such occupations.