Evolução epidemiológica do câncer de próstata no Brasil: análise de rastreamento, desigualdades sociodemográficas e custos em saúde (2015–2025).

Abstract

Objective: To analyze hospital admissions, outpatient prostate-specific antigen (PSA) testing, mortality, healthcare costs, and regional and sociodemographic inequalities related to prostate cancer in Brazil.

Methods: An ecological time-series study was conducted from 2015 to 2025. Data were obtained from DATASUS (SIM, SIH, and SIA) and the Brazilian Institute of Geography and Statistics (IBGE). Men aged 55–69 years diagnosed with malignant neoplasm of the prostate (ICD-10 C61) were included. Variables analyzed comprised hospital admissions, mortality, the deaths-to-admissions ratio, PSA testing, healthcare costs, and sociodemographic characteristics. Descriptive analyses were performed with temporal assessment and comparisons across age groups and Brazilian regions.

Results: A total of 161,628 hospital admissions were recorded, increasing from 12,322 in 2015 to 20,165 in 2025. The most affected age group was 65–69 years, accounting for 74,308 admissions. A total of 62,780,036 outpatient PSA tests were performed, with a decline in 2020 followed by subsequent recovery. The Southeast region showed the highest healthcare service volume, whereas the Northeast presented the highest mortality rate in 2024 (23.65/100,000 inhabitants). Higher mortality was observed among individuals with lower educational attainment, and reduced access to PSA testing was identified in vulnerable municipalities.

Conclusion: Hospital admissions, outpatient PSA testing, and healthcare costs related to prostate cancer increased in Brazil, alongside persistent regional and socioeconomic inequalities. These findings highlight the need to expand access to diagnosis and promote equity in cancer care.

Keywords: Prostatic Neoplasms; Prostate-Specific Antigen; Ecological Studies; Time Series Studies; Health Inequalities; Health Information Systems.

Resumo

Objetivo: Analisar internações hospitalares, produção ambulatorial de antígeno prostático específico (PSA), mortalidade, custos assistenciais e desigualdades regionais e sociodemográficas relacionadas ao câncer de próstata no Brasil.

Métodos: Estudo ecológico de série temporal de 2015 a 2025. Os dados foram extraídos do DATASUS (SIM, SIH e SIA) e do IBGE. Foram analisados homens de 55 a 69 anos com neoplasia maligna da próstata (CID-10 C61). As variáveis incluíram internações, mortalidade, razão entre óbitos e internações, exames de PSA, custos e características sociodemográficas. Realizou-se análise descritiva com avaliação temporal e comparação entre faixas etárias e regiões brasileiras.

Resultados: Foram registradas 161.628 internações, variando de 12.322 em 2015 para 20.165 em 2025. A faixa etária mais acometida foi de 65 a 69 anos, com 74.308 internações. Realizaram-se 62.780.036 procedimentos ambulatoriais de PSA, com queda em 2020 e recuperação posterior. O Sudeste apresentou maior volume assistencial, enquanto o Nordeste apresentou a maior taxa de mortalidade em 2024 (23,65/100.000 habitantes). Observou-se maior mortalidade entre indivíduos de baixa escolaridade e menor acesso ao PSA em municípios vulneráveis.

Conclusão: Observou-se aumento das internações, da produção ambulatorial de PSA e dos custos assistenciais relacionados ao câncer de próstata no Brasil, com desigualdades regionais e socioeconômicas. Os achados reforçam a necessidade de ampliar o acesso ao diagnóstico e promover equidade na atenção oncológica.

Palavras-Chave: Neoplasias da Próstata; Antígeno Prostático Específico; Estudos Ecológicos; Séries Temporais; Desigualdades em Saúde; Sistemas de Informação em Saúde.

1 Introduction

Prostate carcinoma, or malignant neoplasm of the prostate, is the second most common cancer worldwide, according to the American Cancer Society, and the fifth leading cause of cancer-related death among men. In Brazil, according to the National Cancer Institute (INCA), this malignancy accounts for approximately 71,700 new cases annually and is associated with a high mortality rate, representing an increase of approximately 21% compared with the previous decade.

The Southeast and Northeast regions presented the highest mortality rates from malignant neoplasm of the prostate. Regarding oncological surgeries, the highest numbers of hospital admissions were observed in urban centers such as São Paulo (29,226), Minas Gerais (16,950), and Rio de Janeiro (8,063), highlighting disparities related to healthcare infrastructure and the availability of specialized medical services.

Despite these findings, many previously published studies have not examined sociodemographic factors and social inequality as dimensions associated with healthcare burden and prostate cancer mortality in Brazil, emphasizing the need for studies that consider these social determinants of health.⁵˒⁹

The aim of this study was to analyze the epidemiological evolution of prostate cancer in Brazil, with a particular focus on the sociodemographic profile, social inequalities, and healthcare costs.

2 Methodology

This was a descriptive ecological time-series study on prostate cancer in the male population.

The study covered all regions of Brazil and analyzed hospital admissions, outpatient prostate-specific antigen (PSA) testing, mortality, and healthcare costs from 2015 to 2025.

Data were obtained from information systems maintained by the Brazilian Unified Health System Department of Informatics (DATASUS). The databases used included the Hospital Information System of the Unified Health System (SIH/SUS), the Hospital Morbidity Information System (SIH/SUS), the Mortality Information System (SIM/DATASUS), and resident population estimates provided by the Brazilian Institute of Geography and Statistics (IBGE).

The study population consisted of records of men aged 55–69 years diagnosed with malignant neoplasm of the prostate (ICD-10 C61).

The variables analyzed included region, age group, race/skin color, educational attainment, and male sex, excluding records with missing or unknown information.

In addition, prostate cancer mortality rates were calculated by dividing the number of deaths by the corresponding male resident population, according to IBGE estimates, and multiplying the result by 100,000 men. Annual mortality rates were calculated for each region and age group, as well as cumulative mortality rates for the period from 2015 to 2024. Considering the availability of mortality data, mortality analyses were restricted to the period ending in 2024.

Hospital admissions related to prostate cancer were obtained from SIH/DATASUS and analyzed descriptively according to temporal and regional distribution.

Annual death-to-admission ratios according to race/skin color were calculated using the number of deaths recorded in SIM/DATASUS as the numerator and the number of hospital admissions recorded in SIH/DATASUS as the denominator, multiplied by 100. Furthermore, cumulative death-to-admission ratios for the period from 2015 to 2024 were calculated using the total number of deaths within each race/skin color category during the study period divided by the total number of admissions in the same category and multiplied by 100. This indicator was interpreted solely for exploratory purposes, as it does not represent individual disease case-fatality.

Data on outpatient PSA testing were collected from DATASUS (SIA/SUS and SIH/SUS, according to availability), including costs associated with the procedure. In addition, surgical costs related to prostate cancer treatment were analyzed, allowing an economic assessment of healthcare delivery.

Data were organized into time series to evaluate trends throughout the study period, and annual variations were described descriptively. Interpretation of the findings was complemented by a review of national and international scientific literature.

Statistical analysis was descriptive. As the study used aggregated secondary data from public-domain databases without individual identification, approval by a Research Ethics Committee was not required.

3 Results and Discussion

During the study period, a substantial increase was observed in prostate cancer–related indicators in Brazil, demonstrating a progressive rise in hospital admissions, outpatient prostate-specific antigen (PSA) testing, and hospital and outpatient healthcare costs associated with disease management. A total of 161,628 hospital admissions for malignant neoplasm of the prostate were recorded between 2015 and 2025, increasing from 12,322 admissions in 2015 to 20,165 in 2025, indicating an upward trend throughout the time series. In parallel, 62,780,036 prostate-specific antigen (PSA) tests were performed, showing progressive growth over the years, with a marked decline in 2020 followed by subsequent recovery, reaching the highest value in 2025 (7,190,074 tests).

Outpatient PSA testing demonstrated the widespread use of this examination as a tool for clinical investigation, opportunistic screening, and patient monitoring, totaling more than 62 million procedures during the study period, with expenditures exceeding BRL 1.2 billion within the Brazilian Unified Health System (SUS). However, substantial inequality in access to PSA testing was observed when comparing municipalities classified as socially vulnerable with those considered non-vulnerable. Only 3,106,898 tests were performed in municipalities experiencing extreme poverty, whereas 59,645,993 tests were conducted in non-vulnerable municipalities, highlighting a marked disparity in healthcare access. Among vulnerable municipalities, Registro (São Paulo) and Pau dos Ferros (Rio Grande do Norte) stood out, whereas in non-vulnerable areas, testing was concentrated in major urban centers such as São Paulo (São Paulo) and Salvador (Bahia).

Age-stratified analysis revealed a clear increase in healthcare burden with advancing age. Between 2015 and 2025, 161,628 hospital admissions were recorded among men aged 55–69 years, with the 65–69-year age group accounting for the highest number of admissions (74,308), followed by individuals aged 60–64 years (55,982) and 55–59 years (31,338) (Table 1).

Regional comparisons demonstrated a marked concentration of hospital admissions, outpatient PSA testing, and surgical procedures in the most developed regions of the country. The Southeast recorded the highest number of prostate cancer hospital admissions (86,444), followed by the Northeast (38,806), South (25,204), Central-West (7,057), and North (4,117). A similar pattern was observed for outpatient PSA testing, with the Southeast accounting for 32,154,241 tests, followed by the Northeast (12,171,108), South (10,707,502), North (3,944,164), and Central-West (3,803,021) (Table 2).

Regarding healthcare expenditures, the Southeast accounted for BRL 629,996,851.70, representing the largest share of resources allocated to PSA testing, whereas the Central-West presented the lowest expenditure (BRL 71,794,956.37). A total of 93,114 hospital admissions related to oncological surgery were recorded, with the highest numbers observed in São Paulo (29,226), Minas Gerais (16,950), and Rio de Janeiro (8,063), reinforcing the concentration of specialized care in major urban centers. Hospital costs also showed considerable heterogeneity among Brazilian states, with the highest average cost observed in Paraíba (BRL 8,022.50) and the lowest in Amapá (BRL 4,128.19). Likewise, substantial regional variation was found in mortality rates. The Northeast presented the highest mortality rate (23.65 deaths per 100,000 inhabitants), whereas the North showed the lowest (19.43 deaths per 100,000 inhabitants).

Regarding the sociodemographic profile, hospital admissions were most frequent among Brown individuals (77,387), followed by White (64,697) and Black (17,206) individuals, whereas the Asian (2,309) and Indigenous (29) populations accounted for the fewest admissions. Furthermore, analysis of the cumulative deaths-to-admissions ratios between 2015 and 2024 showed that the Indigenous population presented a value exceeding 100% (196.3%). The highest cumulative ratio was observed among Indigenous individuals (196.3%), followed by the Black population (23.57%) and the White population (22.06%) (Figure 2; Table 3).

In addition, deaths from malignant neoplasm of the prostate were concentrated among individuals with lower educational attainment. A total of 27,216 deaths were recorded between 2015 and 2024, with the highest frequencies observed among individuals with 4–7 years of education (7,352), followed by those with 1–3 years (7,188), 8–11 years (6,662), no formal education (3,417), and ≥12 years of education (2,597). This pattern demonstrates an inverse relationship between educational attainment and mortality, suggesting the influence of the social determinants of health on disease prognosis.

The significant increase in hospital admissions for malignant neoplasm of the prostate in Brazil between 2015 and 2025 corresponds to an average annual increase of 5.1% over the study period. These findings are consistent with national studies describing the increasing trend in hospitalizations for malignant neoplasms within the Brazilian Unified Health System (SUS), highlighting prostate cancer as one of the leading contributors.¹⁴ This pattern may reflect both population aging and expanded access to diagnostic services in the country.

The decline in hospital admissions observed in 2020 and 2021 may, in turn, reflect the global impact of the COVID-19 pandemic on oncology services, as also reported in an international systematic review that identified reductions in cancer screening, hospital admissions, and clinically indicated procedures for the management of prostate cancer. The long-term consequences included disease stage progression and delayed diagnoses.¹⁷

The progressive increase in outpatient PSA testing also warrants discussion, as the Brazilian Ministry of Health and several international guidelines do not recommend population-based screening for asymptomatic men or those at low risk of prostate cancer.¹⁵ In these studies, even when shared decision-making was encouraged after discussing potential risks and benefits, the rates of false-positive results, biopsy-related complications, and overdiagnosis were not unequivocally offset by the modest reduction in prostate cancer–specific mortality observed among patients diagnosed at an early stage.¹⁵˒¹⁶

The consistent increase in mortality with advancing age, together with regional and social disparities, may reflect structural inequalities in access to and quality of healthcare. These findings are consistent with Brazilian studies showing that the highest healthcare utilization does not necessarily occur in regions with the highest mortality rates. Although prostate cancer incidence is higher in major urban centers with greater access to screening and specialized treatment, mortality is disproportionately higher among older individuals living in areas of high social vulnerability, suggesting an association between poorer prognosis, reduced survival, and inequalities in access to healthcare.¹⁸

A marked concentration of hospital admissions was observed in the Southeast region (86,444 admissions), indicating the centralization of hospital care in the country's most developed regions. A similar pattern was identified for outpatient PSA testing, with the Southeast accounting for 32,154,241 tests, suggesting greater availability of diagnostic services in these more developed areas.

Cumulative prostate cancer mortality also showed substantial regional disparities, with the highest mortality rates (Figure 1) observed in the Northeast (23.88) and Central-West (23.69) regions and the lowest in the North (22.31). These findings suggest possible delays in diagnosis and reduced access to timely treatment in less developed regions. They further indicate that prostate cancer care in Brazil is distributed according to the installed capacity of healthcare services rather than the epidemiological burden of the disease. These results are consistent with national studies demonstrating marked regional inequalities in prostate cancer incidence, mortality, and treatment, with healthcare services concentrated in the Southeast and South regions and poorer outcomes observed in less developed areas.¹˒³

The findings also revealed substantial disparities in the profile of hospital admissions and deaths from malignant neoplasm of the prostate in Brazil. Regarding race/ethnicity, Brown individuals accounted for the highest proportion of hospital admissions (47.9%), followed by White (40.0%) and Black (10.6%) individuals. These findings are consistent with one of the largest nationwide studies based on data from the Brazilian Unified Health System (SUS) on prostate cancer.¹⁹ This distribution reflects the demographic composition of the Brazilian population, in which individuals self-identifying as Brown constitute the largest racial group, according to the 2022 Brazilian Demographic Census conducted by the Brazilian Institute of Geography and Statistics (IBGE).²⁰

Despite the predominance of hospital admissions among Brown individuals observed in the present study, a systematic review and meta-analysis conducted in Brazil reported a higher prevalence of prostate cancer among Black men compared with both White and Brown men. In that study, prostate cancer prevalence was 9.6% among Black men compared with 5.6% among White men (OR = 1.58) and 10.1% among Black men compared with 6.7% among Brown men (OR = 1.43), demonstrating greater susceptibility of the Black population to the development of prostate cancer, even in the context of Brazil's highly admixed population.⁶

The highest proportion of deaths occurred among individuals with lower educational attainment, suggesting that socioeconomic inequalities influence access to diagnosis and treatment. However, this association should not be interpreted as causal.²¹

Furthermore, analysis of the cumulative deaths-to-hospital admissions ratios between 2015 and 2024 showed that the Indigenous population presented a value exceeding 100% (196.3%), which is mathematically inconsistent. In the year-by-year longitudinal analysis, this indicator exhibited marked fluctuations and mathematical inconsistencies, ranging from 16.67% in 2015 to 600.00% in 2024, including a period of mathematical indeterminacy in 2016, when no hospital admissions were recorded despite the registration of five deaths. These findings highlight an important limitation regarding the compatibility of secondary data for this population group. This value precludes an accurate estimation of the case-fatality rate among the Indigenous population and exposes longstanding gaps in epidemiological surveillance of Indigenous peoples in Brazil. It also demonstrates that the underreporting of race/color information in hospital admission records disproportionately affects Indigenous populations, generating statistical invisibility that masks the true burden of cancer in this group.¹³

Several limitations should be considered. As this study was based on secondary data obtained from DATASUS, underreporting, inconsistencies in data recording, and regional differences in data quality may have occurred. Furthermore, PSA testing does not allow differentiation between screening, diagnostic investigation, and clinical follow-up. The ecological design of the study precludes causal inferences at the individual level. Regarding educational attainment, the simplified categorization and potential underreporting may have limited a more detailed assessment of the social inequalities associated with the observed outcomes. It should also be emphasized that, although educational attainment is an important socioeconomic indicator, it represents only one dimension of socioeconomic status and does not encompass other relevant determinants, such as income, access to healthcare services, and housing conditions.

Additional limitations include regional differences in data quality, the inability to stratify some surgical procedures by age group, the unavailability of mortality data for 2025, and the inherent limitations of secondary databases, including potential confounding factors.

Overall, the present study allowed the analysis of the epidemiological evolution of prostate cancer in Brazil between 2015 and 2025, demonstrating a progressive increase in hospital admissions, outpatient PSA testing, and associated healthcare costs. A total of 161,628 hospital admissions were recorded, showing a consistent upward trend throughout the study period, together with 62,780,036 PSA tests, despite the temporary decline observed in 2020 and the subsequent recovery. Healthcare services were concentrated in the Southeast Region (86,444 hospital admissions and 32,154,241 PSA tests), whereas regions such as the Northeast presented the highest cumulative mortality rates per 100,000 inhabitants (23.88), indicating a mismatch between healthcare service availability and health outcomes.

Furthermore, the disease had a greater impact on older men, particularly those aged 65–69 years, and was strongly influenced by social determinants of health, with higher mortality among individuals with lower educational attainment and reduced access to PSA testing in socially vulnerable municipalities. Overall, the findings reveal substantial regional and socioeconomic inequalities, highlighting the urgent need to expand access to early diagnosis and to strengthen public policies aimed at promoting equity in cancer care across Brazil.

4 Final Considerations

This study analyzed the epidemiological evolution of prostate cancer in Brazil between 2015 and 2025, demonstrating a progressive increase in hospitalizations, outpatient prostate-specific antigen (PSA) testing, and healthcare costs related to the disease. During the study period, 161,628 hospitalizations and 62,780,036 PSA tests were recorded, with a temporary decline in 2020 followed by recovery in subsequent years. Healthcare services were concentrated in the Southeast region, which accounted for the highest numbers of hospitalizations (86,444) and outpatient PSA tests (32,154,241), whereas the Northeast region presented the highest mortality rates.

Furthermore, the greatest disease burden was observed among men aged 65–69 years, and important sociodemographic inequalities were identified, including higher mortality among individuals with lower educational attainment and reduced access to PSA testing in socially vulnerable municipalities. These findings highlight the influence of social determinants on prostate cancer care and reinforce the need to expand access to timely diagnosis, reduce regional disparities, and strengthen public policies aimed at promoting equity in prostate cancer care in Brazil.

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Table 1. Hospitalizations for prostate cancer among men aged 55–69 years according to age group and year of processing, Brazil, 2015–2025.

Source: Ministry of Health – Hospital Information System of the Brazilian Unified Health System (SIH/SUS).

Table 2. Outpatient prostate-specific antigen (PSA) testing by region of Brazil, 2015–2025.

Source: Ministry of Health – Outpatient Information System of the Brazilian Unified Health System (SIA/SUS).

Figure 1. Cumulative prostate cancer mortality rate by region of Brazil, 2015–2024.

Source: Prepared by the authors using data from the Mortality Information System (SIM/DATASUS) and the Brazilian Institute of Geography and Statistics (IBGE).

Figure 2. Cumulative ratio of deaths to hospitalizations for prostate cancer, 2015–2024.

Source: Data extracted from the Mortality Information System (SIM/DATASUS) and population data from the Brazilian Institute of Geography and Statistics (IBGE). The cumulative death-to-hospitalization ratio was calculated by the authors.

Table 3. Hospitalizations and cumulative death-to-hospitalization ratio for prostate cancer according to race/ethnicity, Brazil, 2015–2025.

Source: Data extracted from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS) and the Mortality Information System (SIM/DATASUS), together with population data from the Brazilian Institute of Geography and Statistics (IBGE). The death-to-hospitalization ratio was calculated by the authors.

1. Medical student at Fundación Héctor Alejandro Barceló (FHAB) – Santo Tomé, Corrientes, Argentina. ORCID: https://orcid.org/0009-0007-9117-6405. E-mail: nicoli.viana.alves@hotmail.com ↑

2. Professor of the Nursing Program at Centro Universitário Planalto do Distrito Federal (UNIPLAN) – Guaratinguetá, São Paulo, Brazil. ORCID: https://orcid.org/0009-0003-0361-7153. ↑

3. Registered Nurse graduated from Centro Universitário Teresa D’Ávila (UNIFATEA) – Lorena, São Paulo, Brazil. ORCID: https://orcid.org/0009-0005-2224-5935. ↑