A urine test for intermediate-risk prostate cancer

Researchers at the University of East Anglia (UEA) have shown that a prostate cancer urine test can identify men at intermediate risk of aggressive disease, who can safely avoid immediate treatment and benefit from active surveillance instead. Their study has been published in the journal Life.

The most commonly used tests for prostate cancer include blood tests, a physical examination known as a digital rectal examination (DRE), an MRI scan and an invasive biopsy. However, doctors struggle to predict which tumours will progress to a more aggressive form, making it hard to decide on treatment for many men.

“There is a desperate need for improvements in diagnosing and predicting outcomes for prostate cancer patients to minimise overdiagnosis and overtreatment whilst appropriately treating men with aggressive disease, especially if this can be done without taking an invasive biopsy,” noted UEA’s Dr Jeremy Clark, lead researcher on the new study.

UEA researchers had previously developed a urine test for prostate cancer called the Prostate Urine Risk (PUR) test — the ‘risk’ here referring to the aggressiveness of the cancer and its potential to spread to other organs. Dr Clark explained, “Previously we have shown that PUR can identify men with high-risk cancer which requires immediate treatment and also low-risk cancer that has a very low rate of progression and does not generally need treatment.

“But there is a third category of men with intermediate risk, which falls in between these extremes. Around half of men diagnosed with prostate cancer fall into this group and the treatment pathways for them have been less clear, until now.”

Dr Clark explained that disease progression in intermediate-risk men is associated with the presence of increasing amounts of a specific pathological characteristic (Gleason pattern 4) that is linked to increased risk of disease progression in men with prostate cancer. The new study shows that the PUR test can assess the amount of Gleason pattern 4 without the need for a biopsy, which would normally be necessary to determine whether men should receive active treatment or be managed by active surveillance.

“So not only can PUR measure the presence of aggressive cancer, but it can also measure increasing amounts of aggressive cancer in a prostate,” Dr Clark said.

“This means that it can show us which men at intermediate risk may require treatment and which may instead be managed conservatively with surveillance.

“PUR will also be useful for monitoring disease in men that do not currently require treatment, and flag up the emergence and expansion of aggressive disease.”

The results of the pilot study will be further investigated in a much larger cohort of men using samples collected with a prostate screening box which the patients receive by mail and return samples by post directly for analysis at UEA. The multisite study is being supported by Prostate Cancer UK and Movember.

“We look forward to seeing further validation of this research in a larger study cohort,” said Dr Sarah Hsiao, Director, Biomedical Research and Impact at Movember. “If successful, this non-invasive PUR test may be able to support decision-making process without needing an invasive prostate biopsy that is associated with discomfort and risk of infection.”

Image credit: ©stock.adobe.com/au/stock28studio

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