SIU 2018: Prostate Cancer Screening: Latin American Perspective

Seoul, South-Korea (UroToday) There is significant variation of prostate cancer rates around the world. Prostate cancer incidence rates increased in nearly all countries, except in a few high-income countries. In contrast, the increase in prostate cancer mortality mainly occurred in lower resource settings, with declines largely confined to high-resource countries.

When analyzing Latin-American countries, one must remember that this is a most heterogenous population, varying by race, diet, age, economy, life expectancy, and the availability of cancer registry. Dr. Mendoza-Valdes stressed that there is no such thing as an “Hispanic” race, as the variance among Latin-American population is so significant. These significant differences manifest in the percentage of people under the age of 20 and the life expectancy, that is considerably different among countries in Latin America. Furthermore, the prostate cancer incidence per 100000 people varies considerably in Latin America, from 18 in Peru to 62.7 in Uruguay.

In a screening study in Mexico of more than 3837 patients between the ages of 50 and 75, PSA was performed for early detection. A PSA of over 4 was considered the cut-off for a referral to a transrectal ultrasound guided biopsy. The biopsy was done with 12 core sampling on each side to a total of 24 cores being taken. The results demonstrated the mean age was 59, and 2% of patients had a family history of prostate cancer. In 10.7% of patients the first PSA was higher than 4 ng/ml, and of these patients, 55.6% had a second PSA above 4 ng/ml, translating to 229 patients. In these 229 patients, almost 70% had a PSA  of less than 10 ng/ml, 12% had a PSA between 10-20 ng/ml, and 6% had a PSA of more than 20 ng/ml. Approximately 55.4% of these patients eventually underwent a biopsy with prostate cancer detection rate of 42.5%. Gleason 6 was demonstrated in 66% of these patients, while Gleason 7 was shown in 26% of patients, and Gleason 8 or above was demonstrated in 7.4% of them. In summary, these results showed that a 1/3 of the biopsies demonstrated clinically significant cancer.

In conclusion, prostate cancer in Latin America is as heterogenous as its population. Prostate cancer incidence in Latin America is lower than in Europe or USA and Canada, but it is rising gradually. The real epidemiology of prostate cancer in this part of the world is unfortunately unknown, but a large proportion of the patients have advanced disease. Currently, there are no screening policies in Latin-American countries except for Venezuela. There are some isolated efforts in individual hospitals in various countries, but not organized in a city- or region-wide policies. Dr. Mendoza- Valdes believes that screening should be done in a smart way, especially in countries with a high incidence of the disease. Latin – American countries must invest in education and promotion of screening, and the urologic associations in all relevant countires must take the lead and get involved in this.

Presented by: Arturo Mendoza-Valdés, MD, Mexico City, Mexico

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre  Twitter: @GoldbergHanan at the  38th Congress of the Society of International Urology - October 4- 7, 2018 - Seoul, South Korea

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