DOI: 10.1200/go-26-12900 ISSN: 2687-8941

Racial and Geographic Inequities in Prostate Cancer Mortality in Brazil: A 14-Year Population-Based Analysis of 209,368 Deaths

Cássio Minuzzo, Anita Nunes de Oliveira, Angélica Ferreira de Andrade, Valentina Modesti, Lara Feliciano Potrich, Lívia Salaberry Massarani, Gabriela das Neves Sampaio de Souza, Maria Fernanda Assis, Juliana Boaventura, Fernando de Lima
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PURPOSE

Prostate cancer is the second leading cause of cancer death among Brazilian men. While national age-standardized rates have declined, the racial and geographic distribution of mortality remains poorly characterized. We quantified national and state-level age-standardized mortality trends, racial inequities using population-denominated rates, statistically validated joinpoints, and the intersection between geographic mortality patterns and racial composition across Brazil from 2010 to 2023.

METHODS

Population-based ecological study using all prostate cancer deaths (ICD-10: C61) from Brazil's National Mortality Information System (SIM/DataSUS), 2010-2023. Age-standardized mortality rates (ASMR) per 100,000 men were computed using WHO 2000-2025 world standard population, with IBGE 2024 edition projections (Census 2022-based) as denominators. State-level ASMR was estimated through indirect standardization. Annual Percent Change (APC) with 95% CI was estimated via log-linear regression; joinpoints were identified through segmented regression with F test and 1,000-iteration permutation testing. Race-specific rates used IBGE Census 2010 and 2022 racial proportions with intercensal interpolation.

RESULTS

A total of 209,368 prostate cancer deaths were recorded. National ASMR declined from 16.8 to 14.7 per 100,000 men (–12.2%; APC = –1.18% [95% CI, −1.36 to –1.00]; P < .001), averting 24,781 deaths versus 2010-frozen-rate scenario. A statistically validated joinpoint at 2020 ( F -test P = .002; permutation P = .007) revealed post-pandemic stagnation: pre-pandemic APC = –0.96% (95% CI, –1.12 to –0.79); post-2020 APC = –0.14% (95% CI, –1.94 to +1.69). Black men maintained mortality rates 10%-12% higher than White men across all 14 years (21.1 v 18.9/100,000 in 2023), with Brown men showing fastest-growing burden (APC = +2.77 [95% CI, +2.19 to +3.35]). State-level ASMR varied 2.5-fold (Rio Grande do Sul: 22.0; Pará: 8.7), revealing inverse pattern: states with highest non-White share of deaths recorded lowest ASMR (Pará 79.3% non-White, ASMR = 8.7; Santa Catarina 8.0% non-White, ASMR = 13.8), consistent with diagnostic under-ascertainment in predominantly Afro-descendant Northern states.

CONCLUSION

Brazil's prostate cancer mortality reveals a geographic-racial paradox: declining national rates coexist with pandemic-era stagnation, persistent excess mortality among Black men, accelerating burden in Brown men, and an inverse association between non-White population share and recorded ASMR—indicating that the most racially vulnerable populations are also the most diagnostically invisible. These findings demand race-conscious, regionally-calibrated screening and diagnostic capacity-building, with direct implications for LMIC cancer control globally.

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