Prostate cancer is the second most deadly cause of cancer in Australian men and while digital rectal exams and prostate specific antigen (PSA) tests can help health professionals determine if further investigations are needed, they’re both controversial because they can lead to over-diagnosis and potentially unnecessary treatments.
Now, researchers from the University of East Anglia and the Norfolk and Norwich University Hospital have made a significant breakthrough by developing a urine test that diagnoses aggressive prostate cancer and determines whether men require treatment up to five years earlier than standard clinical methods. The test, dubbed Prostate Urine Risk (PUR), can also identify patients who are up to eight times less likely to need treatment within five years of diagnosis.
Prostate cancer typically develops slowly and often doesn’t require treatment in a man’s lifetime, but it’s currently difficult for health professionals to determine which tumours will become aggressive. A biopsy is actually what diagnoses the cancer, but this can cause significant damage to the prostate.
Researchers hope the experimental test will help large numbers of men avoid harmful biopsies and repeated invasive follow-ups for low-risk patients on active surveillance – where a health provider monitors the progression of the cancer through regular PSA measurements, digital rectal exams, MRIs and further biopsies. The findings were published in the BJU International Journal.
“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,” lead author Shea Connell from UEA’s Norwich Medical School said in a statement.
The research found that up to 75 per cent of men with elevated PSA levels are actually negative for prostate cancer when a biopsy is taken, while 15 per cent of patients who don’t have raised PSA levels actually do have prostate cancer. A further 15 per cent of these cancers are considered aggressive.
And, while many patients initially opt for active surveillance, as many as 50 per cent of those go on to choose treatment – even if they don’t actually require it.
“It’s clear that there is a considerable need for additional, more accurate, tests,” Connell said.
Researchers analysed urine samples from 537 men and identified a mathematical combination of 35 different genes in urine that could help determine if a man was at low, intermediate or high risk.
“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,” lead researcher Jeremy Clark said. “This means that we could predict whether or not prostate cancer patients already on active surveillance would require treatment.”
The study added that current diagnostic tests for prostate cancer are too non-specific to differentiate patients without cancer, men with low-risk disease and those with cancer that needs to be treated. The new test has the potential to improve clinical decision making by differentiating the three groups and could transform the diagnosis and treatment of prostate cancer.
It’s always important to talk about prostate health with a GP and discuss the best testing options for individual cases.
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