Global burden of prostate cancer (1990-2021) from Brazil: trends in disability-adjusted life years, incidence, mortality, and prevalence.

Abstract

Background: Prostate cancer remains a significant public health challenge globally, with marked regional disparities in Brazil linked to demographic, socioeconomic, and healthcare access factors. This study analyzed trends in disability-adjusted life years (DALYs), incidence, mortality, and prevalence of prostate cancer across Brazilian macroregions (1990-2021) using data from the Global Burden of Disease (GBD) database. Joinpoint regression was employed to identify temporal trends and average annual percentage changes (AAPCs), stratified by age and region.

Methods: Data were extracted from GBD 2021, encompassing national and regional estimates. Statistical analyses included age-standardized rates, AAPC calculations, and pairwise comparisons to assess parallelism in trends.

Results: Results revealed substantial regional disparities: Southern and Southeastern regions exhibited the highest DALYs, incidence, and prevalence, patterns that are consistent with better diagnostic infrastructure and aging populations. In contrast, Northern regions showed lower rates but the steepest AAPC increases (e.g., incidence: + 2.59% annually in age group 70-74), suggestive of improving yet insufficient healthcare access. Mortality declined in the South and Southeast (AAPC up to -0.70% in age group 70-74) due to therapeutic advances but rose in the Northeast (AAPC up to + 0.76% in age group 65-69). Prevalence surged nationwide, peaking in older age groups (e.g., 2,619.50 cases/100,000 men in Southern 70-74 age group), indicating prolonged survival. Joinpoint analyses identified non-linear trends, with incidence stabilizing post-2010 following shifts in screening guidelines.

Conclusion: These findings underscore the need for region-specific policies to address inequities in cancer care, enhance early diagnosis, and optimize resource allocation. Strengthening healthcare infrastructure in underserved regions and targeted screening for younger high-risk populations are critical to mitigating Brazil's prostate cancer burden.