Burden, mortality patterns, and treatment disparities of prostate cancer across G20 countries: Insights from the Global Burden of Disease 2023 study.

Abstract

5032 Background: Prostate cancer is the leading male malignancy in G20 nations, yet cross-national disparities in detection, treatment, and outcomes remain insufficiently characterized. This study examines incidence, mortality, and treatment patterns across G20 countries, with attention to socioeconomic and health system factors. Methods: We analyzed prostate cancer incidence, mortality, and disability-adjusted life years (DALYs) in all 20 G20 member states from 1990 to 2023 using GBD 2023 data. Analysis focused on men aged ≥50 years. Age-standardized rates were calculated, and incidence-to-mortality ratios were used as a proxy for early detection and treatment access. Radical treatment rates (surgery, radiotherapy) and PSA screening availability were correlated with survival patterns. Country-level economic estimates included diagnostic, therapeutic, and end-of-life expenditures. Results: In 2023, G20 countries reported 3.24 million new prostate cancer cases and 512,000 deaths, resulting in 11.8 million DALYs. Age-standardized incidence rates ranged from 23.4 to 112.6 per 100,000 men—a 4.8-fold variation—strongly associated with national healthcare development index (r = 0.78, p < 0.001). High-income G20 nations reported incidence-to-mortality ratios between 4.2:1 and 5.8:1, while middle-income countries such as India, Indonesia, and Mexico ranged from 1.3:1 to 1.8:1. India and Indonesia together accounted for 24% of G20 prostate cancer deaths despite contributing only 18% of total incident cases. Radical treatment rates spanned from 8% in India to 68% in the USA, correlating with long-term survival trends. Average healthcare expenditure per prostate cancer death ranged from $2,100 in low-resource settings to $89,400 in high-income countries. Within high-income nations, men in the lowest socioeconomic quintile experienced 2.1 times higher mortality than those in the highest quintile. Conclusions: Marked disparities in prostate cancer burden and treatment access persist across G20 nations, shaped by income level and healthcare system capacity. Strategic expansion of PSA-based screening and curative treatment in middle-income settings could substantially reduce preventable deaths and narrow the outcome gap.