The largest observational analysis of prostate cancer in any public system, drawing on 670,205 DATASUS records from 2008-2023, shows non-white Brazilian men diagnosed at advanced stages III-IV far more often than white men, with 21% metastatic at presentation overall and 16.2% lower treatment spending for non-white patients. This single-country, real-world cohort study (not an RCT) highlights systemic delays in care-seeking tied to information access and social determinants rather than biology alone. Similar patterns appear in U.S. SEER-Medicare data where Black men face 1.7-fold higher metastatic presentation rates even after insurance adjustment, and in a 2022 Lancet Oncology global review of 1.2 million cases across 20 countries documenting consistent racial gradients in stage at diagnosis. The Brazilian analysis missed upstream policy levers: SUS reimbursement lags mean only 1% receive modern AR inhibitors versus docetaxel in 17.8%, amplifying outcome gaps that compound at population scale. Conflicts of interest are minimal (IDOR academic funding) but the observational design cannot rule out unmeasured socioeconomic confounding. These findings reveal how single-payer systems, without explicit equity audits, reproduce broader healthcare stratification seen from São Paulo to Atlanta.