A new urine test for prostate cancer could revolutionise treatment and prevent unnecessary biopsies.
The test is much more sensitive than current methods, picking up how aggressive the disease is and at what point men will need treatment.
The test is designed for men who are suspected of having prostate cancer, as well as those already diagnosed with low risk disease who are on a “watch and wait” approach known as active surveillance.
For men suspected of having prostate cancer, the test can work out which men have aggressive or intermediate levels of disease, and can rule out those without cancer.
This cuts down the need for a barrage of tests, including blood tests, a physical examination known as a digital rectal examination (DRE), an MRI scan or a biopsy.
Meanwhile, for men already on active surveillance, the test could cut follow-up appointments from once every year to once every five years.
Lead author Shea Connell, from UEA’s Norwich Medical School, told PA: “This test could massively reduce the chance of men needing unnecessary biopsies.
“The test is for men with suspected prostate cancer, but can also be used for people already diagnosed with low risk cancer to see when they will need treatment within five years.
“It also identifies men who are up to eight times less likely to need treatment within five years of their diagnosis.”
At present, medics can struggle to identify those patients with an aggressive form of the disease who need immediate treatment from those who are low risk.
The new test hopes to overcome this. It is called the Prostate Urine Risk (PUR) and was developed by a team at the University of East Anglia (UEA) and the Norfolk and Norwich University Hospital (NNUH).
For their study, researchers collected urine samples from 537 men and looked at the expression of 167 different genes, of which 35 were identified as useful markers of risk.
Dr Jeremy Clark, from UEA’s Norwich Medical School, said: “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.
“This means that we could predict whether or not prostate cancer patients already on active surveillance would require treatment.
“The really exciting thing is that the test predicted disease progression up to five years before it was detected by standard clinical methods.
“Furthermore, the test was able to identify men that were up to eight times less likely to need treatment within five years of diagnosis.
“If this test was to be used in the clinic, large numbers of men could avoid an unnecessary initial biopsy and the repeated, invasive follow-up of men with low-risk disease could be drastically reduced.”
Mr Connell added: “Prostate cancer is more commonly a disease men die with rather than from.
“Unfortunately, we currently lack the ability to tell which men diagnosed with prostate cancer will need radical treatment and which men will not.
“Current practice assesses a patient’s disease using a PSA blood test, prostate biopsy and MRI.
“But up to 75% of men with a raised PSA level 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.
“A policy of ‘active surveillance’ has been developed as a way to combat this uncertainty, but it requires invasive follow-ups and constant reminders that a patient has a cancer with an uncertain natural history.
“This results in up to 50% of men on active surveillance self-electing for treatment – whether they need it or not.”
Dr Mark Buzza, global director of biomedical research programmes at the Movember Foundation – which funded the study, said: “The PUR test has enormous potential to transform the diagnosis and treatment of prostate cancer.”
Around 48,000 men are diagnosed with prostate cancer each year in the UK, and more than 11,000 die from it.
Dr David Montgomery, director of research at Prostate Cancer UK, said: “This is an interesting piece of research, which is exploring the potential of a new, less invasive, way to predict how aggressive a man’s cancer will be by testing for the expression of certain genes in his urine.
“If the benefits of this approach are confirmed in larger trials, this could provide more clarity around whether men are likely to need more urgent treatment or can safely remain under active surveillance.
“However, this study compares the test to older methods for predicting whether a man’s prostate cancer will cause harm.
“More research now needs to be done to see how accurate this is compared to the newer, non-invasive methods being offered, such as multi-parametric MRI scans.”
