New urine test offers promise for prostate cancer diagnosis

A new urine test has been developed that could provide earlier diagnosis of aggressive prostate cancer and identify those less likely to require invasive post-diagnosis treatment.

The new experimental test, called ‘PUR’ (Prostate Urine Risk), is intended to reduce the number of low-risk prostate cancer patients that unnecessarily have biopsy and other invasive tests, and provide prognostic information on the need for therapeutic intervention for patients on active surveillance.

The trial was conducted by researchers at the University of East Anglia and the Norfolk and Norwich University Hospital. The test was developed by using machine learning to analyse gene expression in post-digital rectal examination urine samples of 537 men. On examination, a mathematical combination of 35 different genes was created that could produce PUR risk signatures. These signatures were then used to predict the presence of clinically significant intermediate or high-risk prostate cancer (95% CI, 0.70–0.84). In the active surveillance sub-cohort, PUR signatures were able to detect time to disease progression (p<0.001; hazard ratio, 2.86; 95% CI, 1.83–4.47).

Dr Jeremy Clark, lead author on the study from University of East Anglia’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.’

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