Prostate Cancer Screening in Brazil: a single center experience in the public health system

Abstract

Purpose: Incidence and mortality of prostate cancer (PCa) are still increasing in developing countries. Limited access to the health system or more aggressive disease are potential reasons for this. Ethnic and social differences in developed countries seem to make inappropriate to extrapolate data from other centers. We aim to report the epidemiological profile of a PSA-screened population from a cancer center in Brazil. Materials and Methods: We retrospectively selected 9.692 men enrolled in a PCa prevention program, comprising total PSA level and digital rectal examination at the first appointment, associated with complementary tests when necessary. Men aged over 40 years-old were included after shared decision-making process. Prostate biopsy (TRUS) was performed when clinically suspected for PCa. After the diagnosis, patients underwent appropriate treatment. Results: TRUS was performed in 5.5% of men and PCa incidence was 2.6%. Overall ratio between number of patients who needed to be screened in order to diagnose one cancer was 38.9 patients, with 2.1 biopsies performed to diagnose a cancer. Positive predictive value (PPV) of TRUS biopsy in this strategy was 47.2%, varying from 38.5% (<50 yearsold) to 60% (>80 years-old). We evidenced 70 patients (27.9%) classified as low risk tumors, 74 (29.5%) as intermediate risk, and 107 (42.6%) as high-risk disease. Conclusions: PSA-screening remains controversial in literature. In front of a huge miscegenated people and considering the big proportion of high-risk PCa, even in young men diagnosed with the disease, it is imperative to inform patients and health providers about these data particularities in Brazil.

Optimal PSA Threshold for Obtaining MRI-Fusion Biopsy in Biopsy-Naïve Patients

“…Similarly, we postulate that limited access to mpMRI of the prostate and mpMRI-ultrasound fusion biopsies is present globally. For example, in their 2021 report on prostate cancer screening in a single center in Brazil, the authors note that fusion biopsy was not performed due to limited resources [9]. ere are now several prospective randomized trials and multicenter studies that suggest that the addition of targeted biopsy in biopsy-naïve patients increases net csPCA detection [10][11][12][13].…”

“…Similarly, we postulate that limited access to mpMRI of the prostate and mpMRI-ultrasound fusion biopsies is present globally. For example, in their 2021 report on prostate cancer screening in a single center in Brazil, the authors note that fusion biopsy was not performed due to limited resources [ 9 ].…”

Prostate cancer mortality and costs of prostate surgical procedures in the Brazilian public health system

“…In addition to aging, exposure to risk factors, and lack of access to preventive medicine, clinical exams, or treatments are the key components that contribute to the higher incidence and mortality rates (1,11). In many developing countries, there is still an increase in the incidence and mortality rates of PCa, and these may be related to more aggressive tumor types or inadequate access to health care systems (12). This last factor may not be the case of Brazil, as the growth in PCa incidence took place at the same time as access to PCa screening/diagnosis and medical care were increasing (13).…”