Amid concerns about a dramatic increase of prostate cancer diagnoses across the globe, Australian efforts are underway for a database to guide better treatment.
By Cathy O’Leary
An inevitable global surge in prostate cancer is coming, according to experts, with a worldwide doubling of cases to 2.9 million and an 85% increase in deaths to nearly 700,000 by the year 2040.
It is the second most diagnosed cancer in men, and the fifth leading cause of cancer death among men worldwide, with an estimated 1.4 million new cases and 397,000 deaths each year. In Australia, one in five men face a prostate cancer diagnosis in their lifetime.
At a meeting of urologists in Paris earlier this year, a report from The Lancet Commission on Prostate Cancer warned that with ageing populations, even more cases were on the way.
According to the report, the case for prostate cancer screening for all men aged 50–70 years in high-income countries is also strengthening, with improved use of technologies such as MRI and growing evidence for the safety of active surveillance.
Some experts have warned that the medical community worldwide is ill-prepared for the looming tidal wave of cases, arguing that training more urologists, radiation oncologists, pathologists and radiologists will take too long to meet the demand.
But in Australia, a new partnership between the global men’s health charity Movember and SAiGENCI – the South Australian immunoGENomics Cancer Institute at the University of Adelaide – is working to create a transformative database to prevent and slow the spread of prostate cancer.
The Movember SAiGENCI Transformational Integrated Repository – known as MSTIR – will help researchers develop strategies for clinicians to personalise decisions about prostate cancer care. It will combine a range of prostate cancer data in a single location and then analyse biomarkers, unlock trends and diagnostic pathways to improve the overall management and treatment of the disease.
While many biological and clinical datasets from prostate cancer clinical trials and research studies have been collected, this data has almost always been analysed in isolation.
Linking the data
Now, the world-first integrated database, based in Australia, will harness the power of innovative technologies like artificial intelligence and machine-learning to analyse existing data from tissue samples and clinical data from thousands of men worldwide enrolled in clinical trials.
This is considered one of the most reliable strategies to identify new biomarkers and make sure each man gets the right treatment at the right time, to stop aggressive prostate cancer from growing, coming back or spreading rapidly.
A beta version of the database is expected to be ready midway through next year, with plans to scale access in 2026.
Medical oncologist Professor Christopher Sweeney, the inaugural director of SAiGENCI, said the collaboration would bring together many types of researchers from all around the world to help unlock a new level of understanding of prostate cancer.
“This is an exciting and promising opportunity that could deliver more accurate diagnoses, more effective treatments and improved outcomes for men battling this disease,”
he said.
“At the very heart of this unique endeavour is the international team-spirit and sharing of data which is enabling the repurposing and integrating of existing data.”
Professor Sweeney is a clinician researcher whose primary interest is on the management of genitourinary malignancies, in particular prostate and testicular cancers.
He told Medical Forum that the new database’s use of AI and machine-learning would help make discoveries such as new patterns of genes associated with relapse or the development of cancer.
“We will then use this information and aim to develop specific biomarkers to inform which patients should get which treatment,” he said.
“Researchers are constantly aiming to develop better personalised treatments and we have made advances in metastatic castration resistant prostate cancer and localised prostate cancer with a lower risk of relapse.
“MSTIR is focused on a group that has not had their tumours and general genes comprehensively profiled – namely high -risk localised and metastatic hormone sensitive prostate cancer.
“By focusing on the early stage of men who have potentially lethal cancers, we hope to identify strategies to prevent relapse from localised disease or progression to resistant disease.”
Professor Sweeney said the impending surge in prostate cancer cases gave more impetus to the Australian project, and the need to think and work smarter.
“A lot of this surge will come from the developing world,” he said. “There will be a critical need to develop more specific and effective therapies, so all men get the right treatment at the right time, and for the right length of time to avoid futile or needless therapy and decrease costs to society.
“We’re incredibly excited to see what kind of discoveries come out of this.”
In other recent prostate cancer developments, Victorian researchers writing in the Australian Journal of General Practice looked at two conservative management strategies – active surveillance and watchful waiting – that aimed to avoid unnecessary treatment and harm.
They said the distinction between the two approaches was treatment intent, with active surveillance involving close monitoring of low-risk prostate cancer with intent to cure, whereas watchful waiting focused on monitoring for symptoms with the intent to minimise them.
Their research confirmed that both were safe and effective management options, and the decision to choose active surveillance or watchful waiting was determined by life expectancy, disease biology and patient preference.