Regional Disparities in Prostate Cancer Diagnostic Pathways and Mortality in Brazil, 2015-2024
Renan Garcia Artus, Leonardo Storch, Pedro Melo, Pedro Henrique Ribeiro Teixeira, Rafael Amengual Duarte, Lucas Guimarães, Henrique Da Rocha FronchetiPURPOSE
To evaluate regional disparities in prostate cancer diagnostic pathways and mortality in Brazil between 2015 and 2024, using prostate-specific antigen testing, prostate biopsy, and prostate cancer deaths as population-level indicators within the Brazilian public health system.
METHODS
A descriptive, nationwide, population-based study was conducted using publicly available data from the Brazilian Unified Health System. Mortality data were retrieved from the Mortality Information System for deaths attributed to malignant neoplasm of the prostate. Ambulatory production data were obtained from SIA/SUS for prostate-specific antigen testing and prostate biopsy. Variables included year, geographic region, number of prostate cancer deaths, number of PSA tests, and number of prostate biopsies. Absolute counts, temporal variation, and diagnostic-to-mortality ratios were calculated for Brazil and its five geographic regions. Analyses were restricted to 2015–2024 to ensure comparability across all data sources.
RESULTS
Between 2015 and 2024, 160,015 deaths from prostate cancer were recorded in Brazil. Annual deaths increased from 14,484 in 2015 to 17,826 in 2024, representing a 23.1% increase. During the same period, 55,534,397 PSA tests and 435,366 prostate biopsies were approved within the public health system. PSA testing increased by 41.2%, from 4,913,840 tests in 2015 to 6,938,048 in 2024, whereas prostate biopsies remained nearly stable, increasing only 2.0%, from 54,803 to 55,926. Marked regional disparities were observed. The Northeast accounted for 27.9% of prostate cancer deaths but only 14.6% of prostate biopsies, with the lowest biopsy-to-death ratio among all regions (1.42 biopsies per death). In contrast, the Southeast accounted for 42.2% of deaths and 56.2% of biopsies, with the highest biopsy-to-death ratio (3.63 biopsies per death).
CONCLUSION
Prostate cancer mortality increased in Brazil between 2015 and 2024, while prostate biopsy volume did not rise proportionally despite substantial growth in PSA testing. The disproportionate burden of deaths relative to biopsy volume in the Northeast and North suggests regional inequities in access to diagnostic confirmation within the public health system. These findings highlight the need to strengthen referral pathways, urologic diagnostic capacity, and timely access to prostate biopsy in underserved regions.