International researchers have developed an experimental new urine test that diagnoses aggressive prostate cancer and predicts whether patients will need treatment up to five years earlier than current clinical methods.
Titled PUR (Prostate Urine Risk), the test also pinpoints men who are up to eight times less likely to need treatment within five years of being diagnosed.
The brainchild of researchers at the University of East Anglia in England and the Norfolk and Norwich University Hospital, it is hoped the urine test could help large numbers of men skip an unnecessary initial biopsy and repeated invasive follow-ups for ‘low risk’ patients on active surveillance.
Active surveillance typically involves PSA tests every three to six months, a digital rectal examination (DRE) every six months, MRI scans and biopsies at 12 months and three years.
Prostate cancer is the most common form of cancer in men in the UK but the majority of cancers will not require treatment in a man’s lifetime.
The most common tests to detect prostate cancer include blood tests, a digital rectal examination (DRE) an MRI scan or a biopsy.
However, according to researchers, doctors struggle to predict which tumours will become aggressive, making it hard for many men to decide on treatment.
Lead author, Shea Connell from UAE’s Norwich Medical School, said current detection methods lack the ability to reveal which men diagnosed with prostate cancer will need radical treatment and those who will not.
In response, researchers created the PUR test using machine learning to look at gene expression in urine from samples collected from 537 men.
By examining the cell-free expression of 167 genes in urine samples, they found a mathematic combination of 35 different genes that could be used to produce the PUR risk signatures.
The study notes previous urine biomarker tests have been designed specifically for single purposes such as the detection of prostate cancer on re-biopsy (PCA3 test) whereas the new test uses four PUR signatures to provide a simultaneous assessment of non-cancerous tissue and risk groups (low, intermediate and high-risk) to show how aggressive the cancer is.
“This research shows that our urine test could be used to not only diagnose prostate cancer without the need for an invasive needle biopsy but to identify a patient’s level of risk,” Dr Jeremy Clark, of UAE’s Norwich Medical School said.
“This means that we could predict whether or not prostate cancer patients already on active surveillance would require treatment.”
The research, partly funded by the Movember Foundation, was published in the journal BJU International this week.
Dr Mark Buzza, global director of biomedical research programs at the Movember Foundation, said the results were encouraging.
“The PUR test has enormous potential to transform the diagnosis and treatment of prostate cancer.”