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Urine test predicts prostate cancer progression, need for treatment
A urine test developed by researchers at University of East Anglia and Norfolk and Norwich University Hospital in the U.K. appeared to accurately predict whether men with prostate cancer will need treatment as many as 5 years earlier than current methods.
“Current practice assesses a patient’s disease using a PSA blood test, prostate biopsy and MRI. However, up to 75% of men with increased PSA levels are negative for prostate cancer on biopsy. Meanwhile 15% of patients who do not have a raised PSA are found to have prostate cancer — with a further 15% of these cancers being aggressive,” Shea P. Connell, PhD student and researcher at the University of East Anglia’s Norwich Medical School, said in a press release.
“A policy of ‘active surveillance’ has been developed to combat this uncertainty, but it requires invasive follow-ups and constant reminders that a patient has a cancer with an uncertain natural history,” he added. “This results in up to 50% of men on active surveillance self-electing for treatment — whether they need it or not. There is a considerable need for additional, more accurate tests.”
HemOnc Today spoke with Connell about what prompted the development of this test, the results of the study and subsequent research underway.
Question: What prompted the development of this test ?
Answer : We are unsure about what to do with men with low-grade prostate cancer, with watch and wait the current norm for these men. Disease progression triggers treatment, but we have no way to predict this. In the U.K., men diagnosed with low-risk, early-stage disease are invited to receive surveillance. They then usually undergo an MRI and a repeat biopsy and are assigned to PSA surveillance and maybe a repeat biopsy 1 year after. Every year, these men are reminded that they have prostate cancer and that we do not know how to treat them.
Q: Can you describe how the test works?
A: This test appears to be able to predict prostate cancer progression up to 5 years in advance from a single urine sample. In theory, a man diagnosed with early-stage prostate cancer can provide one urine sample and we can tell him if he will be relatively safe for another 5 years without annual follow-up tests. We assess cell-free RNA with NanoString technology, which is similar to a barcode. After this, we look at the expression pattern of 35 different genes and use this in a regression analysis to produce the Prostate Urine Risk, or PUR, risk score.
Q: How did you conduct the current study?
A: This study was a part of the Movember GAP1 Urine Biomarker Project, which was set up to design biomarker panels for prostate cancer because there is a significant problem with overdiagnosis and overtreatment. We collected urine samples from multiple centers across the U.K. in Norfolk and London, and from Dublin and Atlanta. We followed a sub-cohort of men undergoing active surveillance for approximately 5 years from their first urine sample.
Q: What did you find?
A: We found that the expression panel of 35 genes could be used to distinguish biopsy outcome from current methods. We also confirmed that we could predict progression on active surveillance up to 5 years in advance. We still require patients to come to the clinic for an exam, but we are continuing to examine this with our research.
Q: What is next for research?
A: We are now looking at collection of home urine samples, which is being supported by Prostate Cancer U.K. and the Movember Foundation Research Innovation Award, to validate the findings in this current study. This additional research is designed to validate and streamline the urine test into clinics and into clinicians’ hands as soon as possible. – by Jennifer Southall
Reference:
Connell SP, et al. BJU Int. 2019;doi:10.1111/bju.14811.
For more information:
Shea P. Connell can be reached at University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK; email: s.connell@uea.ac.uk.
Disclosures: Connell reports no relevant financial disclosures. The study was funded by the Andy Ripley Memorial Fund, the Bob Champion Cancer Trust, the King family, the Masonic Charitable Foundation, Movember Foundation and the Stephen Hargrave Trust.