Radiotherapy in prostate cancer management in Ceará, Brazil

Abstract

Prostate cancer remains a major public health concern in Brazil due to its high incidence and persistent regional inequalities. Early diagnosis is crucial for effective curative treatments, including radiation therapy; however, socioeconomic and geographic disparities significantly influence access to timely diagnosis and appropriate care. This study presents a descriptive analysis of prostate cancer management in Ceará, Northeastern Brazil, focusing on radiotherapy modalities and associated challenges. A retrospective review of 1,031 medical records from patients treated at the Integrated Regional Oncology Center (CRIO), in Fortaleza, between 2014 and 2023 was conducted. Data on demographic characteristics, disease staging, and treatment protocols were systematically analyzed, with emphasis on radiotherapy. Statistical analyses included Chi-square tests, Kruskal-Wallis tests, and multinomial regression to assess associations between patient characteristics, staging, and treatment decisions. Ethical approval was obtained (Protocol 4310688, Plataforma Brasil), with waiver of informed consent due to the retrospective design and use of de-identified data. The mean patient age was 71.3 years. Most patients were diagnosed with localized (Stage IIB, 36.3%) or locally advanced disease (Stage III, 23.2%), although a considerable proportion presented with Stage IV disease (16.0%). External Beam Radiotherapy (EBRT) was the predominant initial treatment (320 patients), whereas brachytherapy was used in less than 1% of cases. Geographic disparities were evident: 52.5% of patients came from Greater Fortaleza, reflecting the centralization of oncology services. Educational attainment was generally low, with 21.5% of patients illiterate and 63.5% having only elementary education, which may contribute to delayed diagnosis. A significant inverse association between age and disease stage (p < 0.001) indicated that older patients were more frequently diagnosed at earlier stages, while younger patients tended to present with more advanced disease. Overall, the findings reveal systemic barriers to early detection and equitable treatment. The heavy reliance on EBRT, limited availability of brachytherapy—partly due to the lack of domestic source production—and centralized oncology infrastructure highlight the need for improved regional planning, expanded radiotherapy capacity, and targeted strategies to reduce disparities within the public health system.