Prostate Cancer in Latin America: Challenges and Recommendations

Abstract

Prostate cancer (PCa) is the most frequent tumor among Latin American (LATAM) men. The incidence of de novo metastatic PCa is higher in LATAM than other parts of the world, and demographic changes in the region have increased disease burden. However, region-specific information regarding prevalence, progression, and treatment effectiveness is not currently available for nonmetastatic, castration-resistant PCa (nmCRPC). Nonmetastatic, castration-resistant PCa is a heterogeneous disease with varying potential to develop metastasis with limited treatments available, until recently. New clinical trials with promising results have allowed second-generation antiandrogen drugs to be used as first-line treatments, rendering guidelines outdated. As a result, this panel of experts reviewed the current status and challenges and developed recommendations for nmCRPC diagnosis and management in LATAM. The Americas Health Foundation (AHF) conducted a literature review and identified LATAM scientists and clinicians who have published in the field of PCa since 2012. The AHF convened a panel of 7 chosen experts urologists and medical oncologists from the region. The AHF developed specific questions relating to nmCRPC, which were answered by the experts prior to the multiday meeting. Each narrative was discussed and edited by the panel, through numerous rounds of discussion until a consensus was reached in a final manuscript. The panel proposes specific and realistic recommendations for improving access to diagnosis and management of PCa in LATAM. No treatment has yet shown improvement in overall survival; however, when including metastasis-free survival as an end point, second-generation antiandrogen drugs have emerged as effective treatment options and are currently included as first-line treatment. Although nmCRPC is a specific disease that represents a small percentage of patients with PCa, effective diagnostic and treatment strategies can contribute toward increasing quality of life and survival rates of patients with PCa in LATAM.

Incidence, Mortality, Disability-Adjusted Life Years, and Trends of Prostate Cancer in Mexico from 2000 to 2019: Results from the Global Burden of Disease Study 2019

“…In addition, at the national level, PC was the top ranked cause of death among 27 groups of cancers in males, while at the global level, this neoplasm was ranked 4 th . Consequently, our results not only revealed that PC caused a higher burden of disease in males from Mexico when compared to the global reference but also confirmed that in some countries from Latin America, PC is among the main causes of death due to malign neoplasms [15]. It is worth mentioning that even though PC is linked to a high mortality in males from Mexico, the national mortality counts and death rate for this neoplasm are among the lowest in comparison to Argentina, Chile, Cuba, Brazil, Uruguay, and Venezuela, which are some of the countries with the highest mortality rates from the Americas [28,24].…”

“…Previous reports have demonstrated international heterogeneity in the burden of PC across nations [13,14], including countries from Latin America [15]. In the Americas, this geographical and temporal variation might be a reflection of national differences in diagnostic and treatment practices, access to healthcare, registration, and awareness [11].…”

Prostate Cancer Mortality in Peru: An Update from 2003 to 2017

“…We identified roughly 20 deaths per 100,000 men in Peru, similar to other LA countries such as Cuba and Venezuela, but higher compared to Argentina, Brazil, Chile, and Colombia, which are below 15 per 100,000 men (Carioli and Bertuccio, 2020;Reis et al, 2020). This demonstrates heterogeneity in prostate cancer mortality rates in LA countries.…”

Incidence, Mortality, and Trends of Prostate Cancer in Mexico from 2000 to 2019: Results from the Global Burden of Disease Study 2019

“…Increased public awareness and the ease of prostate-specific antigen (PSA) testing have led to PC being considered a public health priority in low-and middle-income settings [4]. In Latin America, the burden of PC follows the global trend [5], although with the existence of heterogeneity among the countries from this region [6]. This heterogeneity exposes the necessity for a further detailed characterization of the PC burden by country, as this information will provide a better overview of the patterns and trends of this disease.…”