Largest study of prostate cancer in Brazil’s public health system reveals racial inequalities in diagnosis and treatment

The largest real-world study ever conducted on prostate cancer in Brazil analyzed data from 670,205 patients treated through the Brazilian Unified Health System (SUS) over a 16-year period, between 2008 and 2023. Published in the Journal of Global Oncology (JCO), the official journal of the American Society of Clinical Oncology (ASCO), the study included researchers from the D’Or Institute for Research and Education (IDOR) and investigated patterns of diagnosis, treatment, and healthcare costs related to the disease across the country. The results revealed significant racial inequalities, including a higher frequency of advanced disease at diagnosis among non-white men and differences in therapeutic investment.

A Unique National Portrait of Prostate Cancer

Prostate cancer is currently the second most commonly diagnosed cancer among men worldwide and the fifth leading cause of cancer-related death in this population. In Brazil, an estimated 71,730 new cases were diagnosed in 2023 alone.

Despite the disease’s relevance, large-scale population studies remain rare in Brazil. To address this gap, researchers analyzed DATASUS (the digital backbone of the country's public healthcare system) records from 670,205 patients diagnosed and treated within the SUS between 2008 and 2023, creating one of the largest databases ever used to investigate prostate cancer in a public healthcare system.

The analysis showed that the average age at diagnosis was 72.9 years. Notably, 21% of patients already had metastatic disease at diagnosis, meaning the cancer had spread to other parts of the body. In addition, non-white men were significantly more likely to present with advanced-stage disease (stages III and IV) compared to white men.

The study was led by Dr. Daniel Herchenhorn, a clinical oncologist at Oncologia D’Or and at the D’Or Institute for Research and Education (IDOR), as well as a researcher at the Latin America Cooperative Oncology Group (LACOG), a nonprofit organization with more than 400 researchers dedicated to cancer research across Latin America.

Differences in Access to More Effective Treatments

In addition to patient characteristics, the researchers also analyzed the therapies used after diagnosis. Among the 125,759 individuals with metastatic disease who received systemic treatment, only 17.8% were treated with docetaxel, a chemotherapy regimen considered standard of care in several international guidelines.

Meanwhile, approximately 25% of patients received first-generation antiandrogens or estrogens, older medications that have not demonstrated a proven survival benefit compared with more modern therapies.

Another important finding involved the use of newer treatments, such as androgen receptor inhibitors, which are widely used in many countries for advanced prostate cancer. Within the SUS, these therapies were administered in only about 1% of cases.

This is largely because many of these medications are not yet funded or reimbursed by the public healthcare system, limiting their availability to patients who rely exclusively on SUS care.

Treatment Costs Also Reflect Inequalities

During the study period, the SUS allocated approximately 1.83 billion international dollars (a measure that adjusts monetary values over time according to purchasing power) to prostate cancer treatment. However, average spending was not distributed equally among racial groups, as expenditures for white patients were 16.2% higher than those for non-white patients.

According to the researchers, this difference may reflect inequalities in access to certain treatments or differences in the stage at which patients enter the healthcare system.

“Although the entire study was conducted within a public healthcare network, the differences observed between white and non-white patients once again highlight racial inequalities in Brazil. Mixed-race and Black populations often seek treatment later than white populations, reflecting disparities in access to information as well as other social factors that may hinder access to healthcare services,” says Herchenhorn.

A Study with International Impact

Beyond revealing important inequalities in Brazil, the study also stands out for its size and the type of data analyzed.

“To our knowledge, no other study has evaluated real-world prostate cancer data from such a large number of patients over such a long period as this one, spanning 16 years. This makes the research particularly relevant from a scientific perspective,” the researcher notes. “These analyses are especially important for countries with socioeconomic conditions similar to Brazil’s, including several nations in Latin America that face comparable challenges in access to cancer diagnosis and treatment,” he adds.

Challenges for the Future of Diagnosis and Treatment

The authors conclude that the high proportion of advanced-stage diagnoses suggests shortcomings in the early detection of prostate cancer within Brazil’s public healthcare system, particularly among non-white populations. At the same time, the low use of modern therapies points to structural barriers that limit access to evidence-based treatments.

By bringing together data from more than half a million patients, the study provides one of the most comprehensive overviews ever produced on prostate cancer in Brazil and may serve as a foundation for developing public policies aimed at reducing inequalities in diagnosis and treatment.

Written by Maria Eduarda Ledo de Abreu