Global viewpoints: evolving epidemiology and treatment patterns of prostate cancer in Asia

OBJECTIVES: There are notable regional differences in the incidence and mortality of prostate cancer (PCa), whose underlying causes are arguably complex and multifactorial. In this review, we analysed the epidemiology, clinical characteristics, efficacy and safety of therapeutic drugs, prevalence of treatment and testing, and trends in PCa survival in Asian Urological Association member countries. METHODS: To investigate regional differences in incidence, mortality, and survival, we used the latest data from the GLOBOCAN 2022 edition, CONCORD-3 study data, and the International Monetary Fund database. RESULTS: Asian men tend to present with more aggressive forms of PCa than their Caucasian counterparts. Paradoxically, survival outcomes are often better in Asian populations despite their more aggressive disease profiles. According to the GLOBOCAN 2022 data, PCa incidence is the highest in North America, Oceania, and Europe, but the lowest in incidence and mortality in Asian countries, despite varying significantly across these countries. Many developing Asian countries continue to experience rising mortality rates from PCa, largely due to limited access to PCa screening and disparities in healthcare infrastructure. While PCa treatments demonstrate comparable effectiveness in Asian populations to that in global trials, access to these therapies remains highly variable across the Asia-Pacific region, highlighting the need for access to improved healthcare policies and systems. In developing Asian nations, the 5-year survival rate (5Y-SR) is shown to be positively correlated with gross domestic product (GDP) per capita, suggesting that economic factors play a key determinant in PCa outcomes in these regions. CONCLUSIONS: Our analysis reveals stark disparities between developed and developing Asian countries, particularly in mortality-to-incidence ratios, prostate-specific antigen screening coverage, access to novel therapeutics, and reimbursement policies. Despite medical advances, economic status and health policy infrastructure remain key determinants of PCa outcomes in Asia. Moreover, our analysis of 5Y-SR relative to GDP per capita underscores the colossal impact of the latter on PCa prognosis.