An analysis carried out by the Brazilian Society of Radiotherapy (SBRT) shows that, of the total of 32 thousand people who should be undergoing treatment for prostate cancer with radiotherapy in the Unified Health System (SUS), at least 10 thousand do not have access to the procedure per year.
The analysis uses data from the Ministry of Health and DataSUS, which points to a total of 71 thousand cases of prostate cancer diagnosed per year in Brazil. Of these, 75% depend exclusively on the SUS for treatment, that is, more than 53 thousand patients with the disease seek the public network.
Radiotherapy, according to SBRT, is indicated in 60% of cases of the disease, totaling 32 thousand patients, but only 22,541 underwent radiotherapy through the public system in 2023.
“Radiotherapy plays a fundamental role in the treatment of prostate cancer, as it can be indicated as primary therapy, or as a complement to radical prostatectomy. In other words, it is very important that patients have access to this modality”, says radio-oncologist Elton Trigo Teixeira Leite, scientific director of SBRT.
What does the Ministry of Health say?
Wanted by CNN the Ministry of Health states that treatment for localized prostate cancer is not limited to radiotherapy and can also be performed through surgery, such as radical prostatectomy [cirurgia para remover a próstata e as vesículas seminais]depending on the characteristics of the patient and the disease.
“Thus, stating that 60% of cases should be treated with radiotherapy can be considered an arbitrary position, as it does not take into account the individualization of treatment, which must be based on several clinical factors and patient preferences”, says a note sent the CNN .
Furthermore, the ministry states that it promotes strategies and investments to expand access to adequate care for cancer treatment. “Between 2023 and July 2024, the department invested more than R$167 million to carry out surgical procedures for prostate cancer. For the same period, more than R$501 million were invested in prostate cancer chemotherapy and R$225 million in radiotherapy”, he says.
“With the Radiotherapy Expansion Plan in the SUS, through the Growth Acceleration Program (PAC), 62 radiotherapy solutions were implemented, 60 of which are in operation and serving users and two others in the final processing process for implementation of services, representing an increase of 22.7% in the installed radiotherapy capacity in the SUS. Between 2017 and 2024, the expansion represents an increase of approximately 36 thousand procedures per year”, completes the note.
The folder also cites the Radiotherapy Program, which replaced 38 obsolete equipment in highly complex oncology hospitals, according to a note, and the Mias Access to Specialist Program (PMAE), which seeks to speed up access to specialized consultations and exams.
“Through the actions, an increase of 15.4% was recorded in the number of radiotherapies carried out in the SUS between 2022 (3,976,414 procedures) and 2024 (4,590,651 procedures), with this last year being a projection in accordance with the pace the procedure is done. Regarding chemotherapy, in 2022 3,908,323 were performed and in 2024 there is a projection of 4,511,270 procedures, in addition to 444,162 scintigraphy performed in 2022 and a projection of 522,018 by the end of 2024”, concludes the note.
For which cases is radiotherapy indicated?
Prostate cancer treatment varies according to the characteristics of the tumor and stage of the disease. According to the National Cancer Institute (Inca), for localized disease — that is, one that has only affected the prostate and has not yet spread to other organs — surgery, radiotherapy and vigilant observation can be offered.
For locally advanced disease, radiotherapy or surgery in combination with hormonal treatment have been used, according to Inca. For metastatic disease, that is, one that has already spread to other parts of the body, the most recommended treatment is hormonal therapy.
Current guidance from the American Cancer Society (ACS) is that radiotherapy can be indicated as the first treatment, with cure rates similar to those of men undergoing radical prostatectomy, for early prostate cancer, without metastases.
According to Leite, prostate cancer tends to grow slowly and, in some early cases, patients can be placed on an active surveillance protocol, without radiotherapy or surgery, but following a routine of consultations and periodic exams.
“We only start to treat if the patient progresses to an intermediate risk, which happens when the tumor changes its pathological characteristics or the PSA (prostate specific antigen) test starts to rise too quickly”, explains the radio-oncologist.
Radiotherapy is also recommended as the first treatment when the tumor has extravasated the prostate capsule or invaded the seminal vesicle. These patients may benefit from radiotherapy associated with hormone blockade.
After surgery, radiotherapy can be applied adjuvantly, for cases in which the tumor cells have not been completely removed; when they extravasate the capsule and/or invade the seminal vesicles, or in the case of PSA relapse, the so-called biochemical relapse.
“As it is a highly sensitive marker, we currently give preference to salvage radiotherapy over adjuvant radiotherapy. However, for equivalent effectiveness, it is important that this rescue is carried out early, that is, starting radiotherapy as soon as the PSA starts to rise consistently, and already with values above 0.1ng/ml”, concludes Teixeira.
In metastatic disease, radiotherapy can be used in secondary lesions, as a means of local and/or symptom control. In selected patients, who have few metastases, radiotherapy to the prostate may also be indicated, as suggested by more current evidence.
This content was originally published in Prostate cancer: 10 thousand patients do not have access to radiotherapy in the SUS per year on the CNN Brasil website.
Source: CNN Brasil
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