Researchers at the University of East Anglia discovered that a prostate cancer urine test can identify men at ‘intermediate risk,’ allowing them to skip immediate treatment and instead benefit from ‘active surveillance.’ A new pilot study illustrates how urine biomarkers can detect the presence of severe cancer in the prostate, showing which men require treatment with more accuracy.
Previously, the team’s Prostate Urine Risk (PUR) test could distinguish between individuals at high and low risk of prostate cancer. However, with some fine-tuning, it can now help men with intermediate-risk disease, for whose treatment options were previously unclear.
In the United Kingdom, prostate cancer is the most frequent cancer in men. It normally grows slowly, and the vast majority of malignancies do not necessitate treatment during a man’s lifetime. Blood tests, a physical examination known as a digital rectal examination (DRE), an MRI scan, and an invasive biopsy are the most routinely utilized testing for prostate cancer. However, doctors are unable to anticipate which tumors may develop to a more aggressive stage, making treatment decisions difficult for many men.
“While prostate cancer is responsible for a large proportion of all male cancer deaths, it is more commonly a disease men die with rather than from,” said lead researcher Dr. Jeremy Clark of UEA’s Norwich Medical School.
We have recently developed a urine biomarker test for prostate cancer named PUR that can distinguish whether men should be placed on active surveillance or have radical treatment
Dr. Jeremy Clark
“Therefore, there is a desperate need for improvements in diagnosing and predicting outcomes for prostate cancer patients to minimise over-diagnosis and overtreatment whilst appropriately treating men with aggressive disease, especially if this can be done without taking an invasive biopsy. Here at UEA, we have developed a urine test for prostate cancer called the Prostate Urine Risk Test — or PUR for short.”
“The term ‘risk’ alludes to the aggressiveness of the cancer and its ability to spread to other organs, ultimately killing the patient.” However, prostate cancer is a very complex disease, and men’s risk levels vary greatly. Previously, we shown that PUR may detect men with high-risk cancer who require prompt treatment, as well as men with low-risk cancer who have a very low likelihood of advancement and do not normally require therapy.”
“However, there is a third group of men classified as ‘intermediate-risk,’ who lie somewhere in between these two extremes. Approximately half of men diagnosed with prostate cancer fall into this category, and treatment options for them have been less apparent until now. It is well established that the presence of increasing quantities of Gleason pattern 4 cancer in the prostate of intermediate-risk men is related with disease progression. According to our findings, the PUR test may detect the amount of Gleason pattern 4 without the requirement for a biopsy.”
“So, not only can PUR detect the existence of aggressive cancer, but it can also detect the progression of aggressive cancer in the prostate. This means that it can tell us which guys at intermediate risk need treatment and which may be treated conservatively with surveillance. PUR will also be valuable for monitoring disease in men who are not currently receiving treatment, as well as detecting the emergence and spread of aggressive disease” He continued.
The results of this 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.
Prof Daniel Brewer, also from UEA’s Norwich Medical School and a visiting worker at the Earlham Institute, said: “Prof Dan Brewer, also from UEA’s Norwich Medical School and a visiting worker at the Earlham Institute, said: “We have recently developed a urine biomarker test for prostate cancer named PUR that can distinguish whether men should be placed on active surveillance or have radical treatment.”
“In this study, we look more closely at the biological changes that PUR detects. This is an exciting discovery that explains why PUR works so well. This test is currently being verified in a large multi-site trial funded by Prostate Cancer UK and Movember,” he said.
“This new research from Dr Clark’s team shows that the PUR test can be used to estimate the level of a specific pathological characteristic (Gleason Pattern 4) that is linked to increased risk of disease progression in men with prostate cancer,” said Dr Sarah Hsiao, Director, Biomedical Research and Impact at Movember.
“This is significant because a prostate biopsy is required to evaluate whether men should get active treatment or be treated by active monitoring if their prostate tumor has different amounts of Gleason Pattern 4. We look forward to seeing this findings validated in a bigger study population. If effective, this non-invasive PUR test may be able to aid decision-making without the necessity for an invasive prostate biopsy, which is associated with discomfort and infection risk.”
