South America has experienced significant changes in recent decades, such as demographic distribution, increased life expectancy, development of health systems, and public health programs. These changes have increased cancer incidence throughout the region, including prostate cancer. Nonetheless, despite recent improvements in health care, cancer mortality rates in South America are almost twice those of developed countries (13.6 vs. 8.4 ASR 100 000),2,3 with a higher incidence of advanced disease, which may derive from a low rate of early detection of the disease, availability of diagnostic methods and limited access to specialized multidisciplinary treatment.
PET/SCAN with prostate-specific membrane antigen (PSMA) and recent omics biomarkers could improve prostate cancer detection, reduce diagnosis of clinically insignificant cancers, and limit unnecessary procedures. Although these strategies are not cost-effective for most South American health systems, particularly in the public sector, they cannot support universal application. Other tools, such as risk calculators like PCPTRC 2. 0 and PBCG, are easy to implement and can improve the benefit of early diagnosis and reduce the danger of overdiagnosis that, combined with increased availability of prostate MRI, also achieve similar results.
Radical prostatectomy (RP) and radiotherapy are the reference treatment for stage I-III PCa. Although any approach cannot be recommended over the other, based on oncologic and functional results, the surgical one is still closely linked to the surgeon's experience and care in reference centers. Nowadays, there is evidence that minimally invasive techniques (laparoscopic and robotic-assisted) may have a shorter hospital stay, postoperative pain, and blood transfusion than open surgery.
Triple therapy (androgen deprivation therapy, docetaxel, and darolutamide/abiraterone) has demonstrated a clear survival advantage, an improvement in radiological progression-free survival without an increase in severe or medically significant adverse events in metastatic castration-sensitive prostate cancer (mCSPC). At the same time, agents directed against the androgen receptor (AR) have demonstrated significant benefits in metastasis-free survival (MFS) and improved survival in castration-resistant non-metastatic PCa, becoming part of first-line therapy. Currently, poly-ADP ribose polymerase (PARP) inhibitor therapy for men with mCRPC whose prostate cancer has DNA repair mutations is a treatment possibility that may prolong their survival; this has led to a strong recommendation for genetic testing for patients with metastatic mCRPC or patients diagnosed with mCRPC with demonstrated mutations in DNA repair genes in their family members. Therefore, health authorities in South America should contribute to increasing the availability and accessibility of these combination therapies, as they have demonstrated a substantial impact on overall survival and are superior to conventional regimens.
Although most of the population of South America has basic health coverage, significant disparities persist between the health systems of different countries, even between different regions within each country.2 There is a large discrepancy in resources, early diagnostic techniques, and access to specialized care. The previous, combined with geographic disparities and low socioeconomic status, can create disadvantages that limit access to referral centers and negatively affect the oncologic outcomes of many patients.1
Written by: Kevin A. Diaz, MD,1 Sandra Liliana Amaya, MD, MSc,1 & Herney Andrés García-Perdomo, MD, MSc, EdD, PhD, FACS1,2
- UROGIV Research Group, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia.
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
- Diaz KA, Amaya SL, García-Perdomo HA. Perspectives on prostate cancer: advances and pending challenges for a multidisciplinary oncological approach in South America. Int Urol Nephrol [Internet]. 2023 Sep 12 [cited 2023 Sep 23];1–7.
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin [Internet]. 2021 May 1 [cited 2022 Oct 2];71(3):209–49.
- Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, R Liedke PE, et al. The Lancet Oncology Commission 1 Progress and remaining challenges for cancer control in Latin America and the Caribbean [Internet]. Vol. 16, www.thelancet.com/oncology. 2015.