Shining a spotlight on ‘below the belt’ cancers

International Men’s Health Week, taking place this week (13-19 June), shines a spotlight on the importance of men’s health and wellbeing in all forms, and celebrates some positive stories from around the globe.

The week serves as more than just a mechanism for reflection – provoking thought into how far support networks and treatments have come over time and how we can pave the way for a better future. These educational touchpoints help to construct a better understanding of our own lifestyles. 

For instance, did you know that one-third of all cancers are preventable through a healthier lifestyle? As a fitness professional, therefore, you actively work to prevent disease and premature death. A pretty good reason to get up in the morning!

Recent studies highlight that exercise is not only a great way to help prevent cancer but actually helps to manage some of the common side effects of treatment and speeds up the recovery period and overall quality of life. Combined with a healthier diet and better lifestyle choices, there’s a higher chance of reducing your risk of recurrence and other health problems. 

Though that may sound obvious, the link between a healthier diet and regular exercise in terms of prevention wasn’t necessarily a clear indicator in the past. Nowadays, it’s a highly regarded prescription used by cancer practitioners for their patients. 

Alongside so many other charities and groups operating across the region, the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP) serves as an example of how this forethought has been taken on board. 

As a multidisciplinary team of doctors, nurses, allied healthcare professionals, scientists, researchers, and community representatives, ANZUP investigates which data deserves more attention, which treatments hold a promise for the future, which drugs should be tested in clinical trials, and most importantly, the main areas of concerns for patients and ways in which alternative lifestyle choices can improve their recovery.

From a clinical trials perspective, and in light of International Men’s Health Week, Dr Ciara Conduit provides some key insights into what the week represents and what advancements hold promise for the future: 

Can you tell us about yourself and your role?

I am a Clinical Research Fellow at the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group helping to develop and support clinical trials and other initiatives for patients with ‘below the belt’ cancers in Australia. By background, I am a specialist Medical Oncologist at Peter MacCallum Cancer Centre, with an interest in genitourinary cancers, particularly testicular cancer, as well as melanoma, new drug development, and communication.

Which research projects are you currently involved in?

In my role at ANZUP, I am fortunate to work with many brilliant Australian clinicians and researchers trying to help answer some of the tough questions that face us in the clinic each day. Recently in this role, my focus has been on the role of immunotherapy in rare variant kidney cancers in ANZUP’s UNISoN clinical trial, as well as personalising chemotherapy for patients with advanced prostate cancer in the GUIDE trial. There are a lot of other exciting studies in the pipeline too!

What does International Men’s Health Week mean to you, professionally?

To me, it’s an opportunity to celebrate those who strive to find answers to the tough clinical questions. Improvements in health outcomes as a result of clinical trials are vital, enabling the development of new interventions, helping to raise standards of treatment, and, crucially, benefiting patients by enabling faster access to the latest treatment. That’s why I do what I do.

In recent history, what are some of the major breakthroughs that have come out of Clinical Trials for below-the-belt cancers?

There have been significant advances in treatment opportunities for patients with below-the-belt cancers in recent years, led by international collaborations.

In Australia and through ANZUP, we have been involved in many of these important advances including:

• ENZAMET / Prostate Cancer- The landmark Australian-led clinical trial, ENZAMET, showed that hormone therapy with a drug called enzalutamide can improve the survival of some men with advanced, hormone-sensitive prostate cancer.
• TheraP / Prostate Cancer – a new treatment for advanced prostate cancer using Lutetium-177 PSMA radionuclide therapy (Lu-PSMA). The primary endpoint of the study was to compare the effects of the two treatments on change in PSA, a blood biomarker of prostate cancer. A favorable response, defined by a reduction of PSA by 50% or more, occurred in 66% of men assigned to receive ¹⁷⁷Lu-PSMA-617 compared to 37% with cabazitaxel chemotherapy.
• Immunotherapy in kidney cancer – UNISoN tests whether new immune treatments can help people with rare kidney cancer (‘non-clear cell’ cancer).
• Bladder cancer – world-first SUBDUE-1 trial, which saw the immune-stimulating cancer drug durvalumab injected directly into patients’ bladder tissue, rather than a vein, for the first time.
• Testicular cancer – Several decades ago testicular cancer was a disease with a very poor prognosis. But now, because of new treatments, tested carefully in clinical trials, it is almost always curable, even when it has spread.
• ENZA-p/ Prostate Cancer – Precision medicine is the concept of targeting the right patient for the right treatment at the right time. ENZA-p is a clinical trial that aims to use new theranostic agents to allow more accurate prognostic decision making, and subsequently, more effective personalised treatment with fewer side effects for men confronting metastatic castrate-resistant prostate cancer.

What sort of areas will Clinical Trials into below-the-belt cancers be focusing on in the future?

Oncology is a rapidly changing field, and it is sometimes hard to predict how different things may look in just a short period of time. At ANZUP, we’re excited about the future and focusing on blood-based and imaging biomarkers to help personalise care, as well as novel treatment approaches that might offer patients better cancer control and quality of life, amongst other things. We look forward to seeing how new LuPSMA therapies will transform care in prostate cancer after the results of TheraP and other studies. The following are just some of the current and upcoming trials at ANZUP.

What do survival rates look like at the moment for ‘below the belt’ cancers in Australia and what will they look like in the future?

Prostate cancer: 95% five-year survival rate after diagnosis, approximately 3,150 deaths in Australia each year. The five-year survival rate for men diagnosed with prostate cancer has increased over the years from 60% to 95%. Nearly all patients who present with localised disease will live beyond five years.

Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the second most common cancer in young men (aged 18 to 39) excluding non-melanoma skin cancer. However, this form of cancer is highly treatable, even when cancer has spread beyond the testicle. It was estimated only 980 men would be diagnosed with testicular cancer in Australia in 2021. This equates to 1% of all cancers in men. For Australian men, the risk of being diagnosed with testicular cancer by the age of 85 is 1 in 202. The rate of men diagnosed with testicular cancer has grown by more than 50% over the past 30 years, however, the reason for this is not known.

Bladder cancer was the 11th most commonly diagnosed cancer in Australia in 2021. In 2021, it was estimated that 3066 cases of bladder cancer would be diagnosed in Australia (2369 males and 697 females). This is equivalent to an estimated incidence rate of 9.3 cases per 100,000 persons. Bladder cancer is more common in men than women and in people aged over 60 years. In addition, it was estimated there would be 1020 deaths in Australia from bladder cancer but from 2013 to 2017 on average, 55.3% of people diagnosed with bladder cancer survived 5 years after diagnosis. Among Australia’s 15 most common malignancies, bladder cancer remains the only one with survival rates that have worsened over the past 30 years.

Kidney cancer has become increasingly more commonly diagnosed and survival rates continue to improve. This cancer is the 7th most diagnosed cancer in Australia and in 2021 it was estimated there would be 4,377 new cases of kidney cancer diagnosed (2,936 males and 1,441 females). Kidney cancer is rare in people under 40 but the risk does increase with age. Also, men are almost twice as likely to be diagnosed with kidney cancer as women.

Penile cancer is rare. In 2021 there were an estimated 155 cases of penile cancer diagnosed and 28 deaths from this disease. From 2013 to 2017, on average, 75.4% of males diagnosed with penile cancer survived 5 years after diagnosis. In 2021, the estimated age-standardised incidence rate of penile cancer is 1.1 cases per 100,000 males.

*https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/summary

How does Australia compare to the rest of the world when it comes to trials and research into below-the-belt cancer?

ANZUP has been extremely successful in a relatively short space of time with leading global pivotal studies in below-the-belt cancers. The data from these studies have had a major impact on clinical practice, as best evidenced by a study such as ENZAMET. This study was a key factor in enzalutamide being approved by the Food and Drug Administration (FDA) in America, for metastatic hormone-sensitive prostate cancer. This was a major milestone.

ANZUP
The Australian and New Zealand Urogenital and Prostate Cancer Trials Group was formed in 2008, bringing together a world-leading multidisciplinary team of doctors, nurses, allied healthcare professionals, scientists, researchers, and community representatives, all working in areas related to urogenital cancer, also called below-the-belt cancers. anzup.org.au

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