Prostate Cancer Treatment Patterns and Inequities Among Racial Groups in Brazil's Public Health System: Insights From...

The Brazilian Public Health System (BPHS) provides sole health coverage for approximately 77% of the population. Analyzing BPHS data enables nationwide assessment of epidemiology, treatment patterns, and costs for men with prostate cancer (PCa).

We conducted a retrospective, population-based cohort study using linked administrative data from the BPHS Database DATASUS for patients with PCa treated in the BPHS from January 1, 2008, to March 31, 2023. Variables include demographics, clinical features, stage, treatments, and health care utilization. The primary objective was to evaluate the impact of race on stage at diagnosis, treatment delivery, and treatment costs.

A total of 670,205 patients with PCa were treated during the study period; 277,030 (41.4%) were White and 393,175 (58.6%) non-White. Mean age at diagnosis was 72.9 years (40-99). Approximately 56% were diagnosed with stage I-III disease (56.1% v 55.5%), and 21% with metastatic disease (19.7% v 21.2%), with non-White men more frequently presenting with advanced stage (P < .001). White men more commonly received local therapy in stage I, whereas non-White men received local therapy more frequently in stage III (P < .001). Among 125,759 men with stage IV disease who received systemic therapy, only 22,393 (17.8%) received docetaxel, while use of first-generation antiandrogens and estrogens remained high (25%). Total PCa-directed expenditures reached In$ 1.83 billion, with mean costs 16.2% higher for White patients than for non-White patients.

In the BPHS, race was associated with more advanced stages at diagnosis and differences in treatment delivery. High rates of de novo metastatic disease, underuse of docetaxel, and persistent use of agents without survival benefit highlight urgent gaps in PCa care. These findings may guide PCa policy in Brazil and other low- and middle-income countries.