PERFIL CLÍNICO-EPIDEMIOLÓGICO DOS PACIENTES SUBMETIDOS A BIÓPSIA DE PRÓSTATA NO CENTRO DE DIAGNÓSTICO DE CÂNCER DE PRÓSTATA (CDCP/INCA) ENTRE 2018 E 2025

Abstract

Prostate cancer (PCa) is the most common solid neoplasm among men in Brazil, excluding non-melanoma skin cancer, with an estimated 77,920 new cases annually (2026 to 2028). It is a biologically heterogeneous disease, ranging from indolent to aggressive forms, with significant metastatic potential. In low- and middle-income countries, late diagnosis and unequal access to health services result in a higher proportion of advanced cases. OBJECTIVES: This study aims to describe the clinical and epidemiological characteristics of men undergoing prostate biopsy at the Prostate Cancer Diagnostic Center (CDCP) of the National Cancer Institute (INCA) between 2018 and 2025, correlate PSA with ISUP grade, evaluate the association between race and biopsy positivity, and correlate age, socioeconomic status, and total marital status with ISUP. MATERIALS AND METHODS: A retrospective and observational study was conducted, with prospective data collection since the creation of the Prostate Cancer Diagnostic Center (CDCP/INCA), including all patients who underwent transrectal ultrasound-guided prostate biopsy with 12 fragments at CDCP/INCA between January 2018 and August 2025. Only conclusive histopathological results were analyzed. Data were anonymized and processed in RStudio®. Multinomial and binary logistic regression models, as well as Spearman's correlation, assessed associations between PSA intervals, ISUP grade, race, age, and socioeconomic factor, with statistical significance defined at p<0.05. RESULTS: A total of 13,085 biopsies were performed, of which 7,513 (57.4%) were positive for prostate cancer—above international averages (44%). The number of biopsies increased until 2023, with a temporary drop during the COVID-19 pandemic. Most patients were ≥70 years old (60.1%), white (54.3%), and of low socioeconomic status (93% earned ≤3 minimum wages); 60% had only primary education. PSA >20 ng/mL was strongly associated with high-grade tumors (ISUP 4–5; or >20.0, p<0.01). Black men were 35% more likely to have a positive biopsy compared to white men (OR=1.35), while Asian patients had lower odds (OR=0.77). Among positive cases, 50% had an ISUP ≥4. Age and socioeconomic factors showed a low correlation with ISUP, with statistical significance (p<0.05). Surgery was the predominant treatment (63.2%), followed by active surveillance (33.9%), radiotherapy (1.6%), and systemic therapy (1.3%). Robotic surgery was performed in 36.1% of operated patients, reflecting the growing incorporation of minimally invasive technology in the Brazilian public health system. CONCLUSIONS: CDCP/INCA has established itself as a national reference center for PCa diagnosis, performing over 13,000 biopsies between 2018 and 2025. The high prevalence of positive byopsies among elderly, low-income and high grade desease in black people highlights the urgent need for earlier detection and equitable access to care. The INCA experience demonstrates the feasibility of integrating technological innovation, standardized protocols, and universal access in a public healthcare setting,offering a reproducible and sustainable model for oncologic public policy in developing countries .