Genitourinary Oncology in Latin America: Challenges, Progress, and Collaboration - Juan Pablo Sade

December 21, 2022

Juan Pablo Sade highlights the unique challenges and advancements of genitourinary oncology in Latin America. As a rapidly developing specialty, it benefits from a multidisciplinary approach involving urologists, radiologists, and genetic counselors. Dr. Sade emphasizes the region's heterogeneity in practice and access, leading to varied disease management and late diagnoses, particularly in non-academic settings. He points out the excessive use of chemotherapy for metastatic prostate cancer due to healthcare access issues and a more paternalistic patient-doctor relationship. Despite these challenges, Dr. Sade is optimistic about Latin America's potential to contribute to global oncology, thanks to its distinct population and growing involvement in clinical trials.


Juan Pablo Sade, MD, Alexander Fleming Institute and the Austral University Hospital in Buenos Aires

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Juan Pablo Sade: Hi, how are you? My name is Juan Pablo Sade. I am a medical oncologist. I am a specialist in genitourinary tumors. I only work in genitourinary oncology. I’m the head of the Department of Genitourinary Cancers at the Alexander Fleming Institute, which is a private and academic institution in Buenos Aires. I’m also leading the genitourinary tumor department at the Austral University Hospital, which is another university and academic teaching hospital in the province of Buenos Aires. In both institutions, we work with a large multidisciplinary team of professionals.

Genitourinary oncology in Latin America has a few specificities. The first of these is it's a very new specialty. We talked about this with Dr. Daniel Castellano. We are here together at UroTarget in Mendoza, and we have talked about the youth of this specialty. It started with oncologists doing genitourinary after doing other specialties or subspecialties, such as gastrointestinal, breast, or lung oncology, and then work was done differently, I would say, with more of a multidisciplinary approach.

From the beginning, we have insisted on incorporating urologists, on working together, and then other specialties were added, that are vital today: radiologists, nuclear medicine doctors, genetic counselors. The team is growing, especially in academic and private medical institutions where we work. This is a daily reality, but Latin America is a very heterogeneous region, very heterogeneous in many aspects.

First, there are many countries, big countries where there is not a true genitourinary oncology practice, and oncologists continue to work as general practitioners, and the genitourinary portion occupies a small percentage of their practice, and that makes it very difficult to keep up with all of the new advancements when an oncologist practices on all of the tumors.

And patients are the ones who lose out.

Then, in institutions that are not academic and not private, in the public sector, which is the case for most of the populations in Latin America, and in community hospitals, multidisciplinary work is very rare. There is still a lot of work to do there. This has resulted in that in Latin America, in general, a diagnosis is provided later compared to other regions and there is more heterogeneous management of each of these pathologies. This happens fairly frequently. In some countries, most patients show up, for example, with metastatic prostate cancer because there is no early screening.

This also results in the fact that in the region, we often use a lot of chemotherapy to treat metastatic prostate cancer, because of the problem of access to health care and because we have a lot of metastatic patients. Added to this is the fact that healthcare is very paternalistic in Latin America.

So overall, the patient does not question his doctor but rather follows his advice, and when the doctor suggests chemotherapy, he agrees to do chemotherapy, and there is not much discussion about it. Bladder cancer is prevalent in some countries, but not all.

This is very frequent in Argentina, but not so much, for example, in Colombia. This has to do with the genetic makeup of the population, and it also has to do with the fact we eat a lot of meat. We smoke a lot, but bladder cancer is very irregularly handled pathology.

By not having multidisciplinary teams, bladder cancer is one of the pathologies that suffers the most concerning its treatment, not enough is done, whether we are talking about adjuvant or neoadjuvant chemotherapy, and the treatment of metastatic disease is also irregular.

So, it is one of the pathologies that suffers the most concerning its treatment. Bladder cancer, that is. Testicular cancer is a pathology where things are clearer. There are some countries like Brazil, with a high incidence of penile carcinoma.

Argentina, in the north of the country, has a high incidence of penile carcinoma. This is a region that has vast experience in treating this rare pathology of the genitourinary system. And kidney cancer is also very common in most countries, especially due to diet and lifestyle. It is also generally diagnosed in more advanced stages because imaging studies are not performed on patients as much as in other regions around the world. Consequently, those of us involved in this specialty work hard, and what we want is to have greater international representation.

We believe we can provide data from our region; we are a phenotypically and genotypically distinct population, which is very interesting. We see in our practice that the results from the rest of the world do not always apply to our daily practice, and we want to conduct more clinical trials. We have grown each time we have more clinical trials, which have been concentrated in some institutions, but for many years, we have been doing well in clinical trials and we want to have more international representation.

Personally, I have had the opportunity and joy since a few years ago to be part of the APCCC, of the Advanced Prostate Cancer Consensus Conference that is held in Switzerland along with Fernando Maluf, a friend and colleague from Brazil. We represented Latin America at that Conference, and it is one of those achievements that makes me proud. And it is a real responsibility.

So, the region has grown. I would like to say one last thing, which I think is very important. We are a relatively small community and are very interconnected with other countries. We all know each other, we travel together frequently, we have conferences, like this one of UroTarget’s, and there is a feeling of friendship and essential collaboration which I think cannot be reproduced in other areas of the world.

So I think we have great potential, a great desire to work, much to learn, much to improve, and we are excited. To me, I think this is the most important message. I want to thank UroTarget, that has invited us, and of course, I want to thank UroToday, that has been incredibly generous by interviewing us and coming here to share this experience with us.

When we first heard about this when we were at the ASCO GU conference, we were extremely excited to have them here, but also felt it was a great responsibility. So there is no doubt they are helping our growth in the rest of the region and the world.

So special thanks to UroToday.