The management of prostate cancer can differ significantly across countries, depending on the availability and accessibility of healthcare resources. The aim of this study was to evaluate current practices in prostate cancer screening, diagnostic imaging, and systemic treatment strategies across Asia and Oceania, with emphasis on access to PSA screening, PSMA PET imaging, early detection rates and treatment patterns.

A cross-sectional anonymous online survey was conducted on Google Forms between November 2024 and January 2025. Survey invitations were sent via email to urologists who are members of the Urological Association of Asia (UAA). The survey underwent a trial run with several urologists to test functionality and comprehension prior to dissemination. Trends in PSA screening, imaging access, stage at diagnosis, and treatment patterns for diseases such as metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castrate-resistant prostate cancer (mCRPC) were examined.

In total, 204 responses were collected and analysed from urologists in 20 countries – Australia, Bahrain, Bangladesh, Cambodia, India, Indonesia, Iran, Japan, Malaysia, Myanmar, Nepal, Pakistan, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, Turkey and Vietnam. Around 50% of respondents were from Indonesia and 18% were from India. Around 90% were board-certified urologists while the remaining 10% were residents in training. Considerable variation was observed across countries. PSA screening was government-approved in a minority of settings, such as Australia, Vietnam and India. PSMA PET availability was high in countries such as Australia, Singapore, South Korea but limited in others such as Pakistan. Early-stage diagnosis (<25% metastatic) was most common in countries with both PSA screening and PSMA PET, such as Singapore and South Korea. Regarding mHSPC treatment, androgen deprivation therapy (ADT) and androgen receptor signaling inhibitors (ARSI) combinations were widely used in high-resource countries such as Australia and South Korea, while triplet therapy such as ADT, ARSI and docetaxel combination adoption varied, with reported usage by urologists of 42.9% in Singapore and 37.8% in India. However, several regions continue to face limited access to newer agents and diagnostic tools due to high cost and limited reimbursement.

Significant disparities in prostate cancer management persist across Asia and Oceania. Early detection correlates strongly with access to both PSA screening and advanced imaging. Investment in healthcare infrastructure and equitable access to novel diagnostics and therapies are essential to improving outcomes across the region.