Urine Test Might Dictate Prostate Cancer Treatment
HealthDay Reporter
WEDNESDAY, June 26, 2019 — A man who learns he has prostate cancer faces a difficult choice: whether to immediately treat the cancer despite potential side effects or wait and see if it’s a slow-growing tumor that never needs treatment.
Men may soon have help making that decision.
Researchers from the United Kingdom report that they’ve created a urine test that can predict the aggressiveness of a prostate cancer far sooner than standard methods.
The new test is called the prostate urine risk test, or PUR. The researchers said it spots men who are up to eight times less likely to need radical treatment within five years of diagnosis. PUR also offers clues about who might need treatment five years sooner than current tests.
Dr. Durado Brooks is vice president of cancer control interventions for the American Cancer Society. He wasn’t involved in the current research, but said the study was “really intriguing.”
“Anything that helps us predict who will have more progressive disease, or who will be less likely to progress, would be helpful,” he said. “And, it appears, based on a modest sample size, that this tool may offer some promise.”
Prostate cancer typically grows slowly and may never need treatment in a man’s lifetime. However, predicting which men do need treatment isn’t easy.
These invasive procedures and constant reminders that they have cancer leads many men to choose treatment, even if they’re not sure they need it, the researchers explained.
Performance Of The 24
The diagnostic accuracy of the 24-Gene Classifier to identify clinically significant and insignificant PCa in the 5 ISUP Grade Groups in the combination cohort was tested and compared. The result showed higher accuracy in ISUP Grade Group 1 and 2 , than in the ISUP Grade Group 3, 4 and 5 . More importantly, the diagnostic accuracy of the 24-Gene Classifier in the combined ISUP Grade Group 1 and 2 cohort and the combined ISUP Grade Group 35 cohort was assessed and compared. The 24-Gene Classifier had higher sensitivity but lower specificity in the ISUP Grade Group 1 and 2 cohort than in the ISUP Grade Group 35 cohort .
Table 5. Diagnostic performance of the 24-Gene Classifier for identification of clinically significant prostate cancer or prediction of biochemical recurrence and cancer metastasis in the ISUP Grade Group 1 and 2 Cohort, ISUP Grade Group 3-5 Cohort, and patients with biochemical recurrence and cancer metastasis.
Table 6. Diagnostic performance of the 24-Gene Classifier and Gleason score for identification of clinically significant prostate cancer by logistic regression in the Gleason Score 67/ISUP Grade Group 13 Cohort and Gleason Score 7/ISUP Grade Group 2 and 3 Cohort.
Your Psa Is Going Up Whats Going On With Your Prostate Good News: Second
Your PSA is going up. Whats going on with your prostate? Do you need a biopsy? Or, maybe youve already had a biopsy that didnt find cancer, but your urologist is wondering whether you need another one. Whats the next step?
Good news: You dont have to move directly to having needles stuck in your prostate! Its not the Monopoly bad-case-scenario of Do not pass Go, do not collect $200! There is a next step! Its a second-line test: a blood or urine test that can provide other layers of information beyond the basic PSA test. There are several good ones out there. Which one do you need? Well, as Marlon Brando said in the classic 1953 movie, The Wild One: Whadya got?
Theres no shortage of options! There are blood tests that provide more nuanced information than the basic PSA test, plus urine tests and even, if youve already had a biopsy, molecular biomarker tests, which arent done on body fluids but on tissue samples. These tests can be helpful, not only in diagnosing cancer, but in risk stratification predicting which cancer is more likely to be aggressive, and which cancer is less likely to need immediate treatment.
Now, about those other blood tests: In addition to the free PSA test, here are two more that include free and total PSA, but look for other factors, as well:
Don’t Miss: Prostate Cancer Prognosis By Age
The Problem With Surveillance
When a man is put into the active surveillance category, it can require invasive follow up.
Active surveillance can involve taking a PSA blood test every three months and then having an MRI or biopsy every two years.
The status is also a constant reminder that the person has cancer but his future is uncertain.
About 50 percent of men who partake in active surveillance wind up treating the cancer, even if it doesnt require treatment, researchers noted.
We currently lack the ability to tell which men diagnosed with prostate cancer will need radical treatment and which men will not, Shea Connell, PhD, a researcher and associate tutor at Norwich Medical School and the studys lead author, said in a statement.
Its clear that there is a considerable need for additional, more accurate tests, Connell said.
Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
Also Check: Average Recovery Time For Prostate Removal
Don’t Miss: How To Take Turmeric For Enlarged Prostate
Identification Of A 24
The National Comprehensive Cancer Network guidelines classify PCa into five risk groups and recommend that most patients in the very high, high, and unfavorable intermediate risk groups receive treatment, while most patients in the very low, low, and favorable intermediate risk groups are placed on active surveillance. Therefore, the very high, high, and unfavorable intermediate risk groups can be classified as clinically significant PCa, and the very low, low, and favorable intermediate risk groups are classified as clinically insignificant PCa. This classification is clinically meaningful and can guide treatment decisions. We used this classification as the standard for the development of a molecular classifier.
In a previous study, we screened PCa-specific biomarker candidates and identified a 25-Gene Panel capable of distinguishing PCa from benign prostate as well as distinguishing clinically significant and insignificant cancer . Using a similar strategy, we screened various combinations of the biomarker candidates to develop a more accurate gene classifier for identifying clinically significant and insignificant PCa, especially in the low/intermediate-grade/ISUP Grade Group 13 cancer patients. We found a 24-Gene Classifier with an algorithm had the highest diagnostic accuracy, including CCND1, HIF1A, FGFR1, BIRC5, AMACR, CRISP3, FN1, HPN, MYO6, PSCA, PMP22, GOLM1, LMTK2, EZH2, GSTP1, PCA3, VEGFA, CST3, PTEN, PIP5K1A, CDK1, TMPRSS2, ANXA3, and CCNA1.
Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
Recommended Reading: Gleason Score 6 Prostate Cancer
Why Is A Prostate
A PSA blood test is performed to detect or rule out prostate cancer. The amount of PSA in the blood is often higher in men who have prostate cancer. However, an elevated PSA level does not necessarily indicate prostate cancer. The U.S. Food and Drug Administration has approved the PSA blood test for use in conjunction with a DRE to help detect prostate cancer in men age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about how to interpret a PSA blood test, its ability to discriminate between cancer and problems such as BPH and prostatitis, and the best course of action if the PSA level is high.
When done in addition to a DRE, a PSA blood test enhances detection of prostate cancer. However, the test is known to have relatively high false-positive rates. A PSA blood test also may identify a greater number of medically insignificant lumps or growths, called tumors, in the prostate. Health care providers and patients should weigh the benefits of PSA blood testing against the risks of follow-up diagnostic tests. The procedures used to diagnose prostate cancer may cause significant side effects, including bleeding and infection.
Advantages Of Tgia And Ria Assays Over Current Urine Cytology Assays
As described, both assays provide a very high level of detection sensitivity . In comparison, the conventional urine cytology tests such as IFA or colorimetric microscopic assays for the detection of urinary PCa cells can only achieve a minimum sensitivity of about 103 cells/mL of the original urine sample, as the traditional cytospin approach requires at least one thousand cells for consistent cell capture from urine, which is often not present in PCa urine specimens. Capturing low numbers of PCa cells from urine using the described filter membrane adapted from the method of Nickens et al.. is an important aspect of this work in increasing the applicability of the TiGA cytology assay whereas the RiA does not require cell capture. Eskra et al. have concluded that while cytology techniques can deliver high specificity, the low sensitivity represents a severe limitation to the practicability of the current approaches. The two new urine cytology assays described in the manuscript offer the specificity of the MIL 38 antibody for the Glypican antigen expressed in PCa cells with the increased sensitivity derived from the improved cell detection technologies described.
Don’t Miss: Monoclonal Antibodies For Prostate Cancer
Prostate Cancer Screening: Everything You Need To Know
A prostate cancer outlook can be good when a person receives an early diagnosis from a doctor. Several prostate cancer screening tests are available for doctors to detect it.
Among males in the United States, prostate cancer is the most commonly diagnosed cancer. Experts estimate that there will be new cases among males in the U.S. by the end of 2022.
Prostate cancer may occur more often in:
- People assigned male at birth: The prostate is part of the male reproductive system.
- Older adults: Doctors detect about 60% of the diagnoses in people who are more than 65 years old.
- Non-Hispanic Black males: They may experience a higher chance of getting prostate cancer due to socioeconomic or health inequities.
If people receive a prostate cancer diagnosis early, the outlook can be good. But oftentimes, prostate cancer does not cause symptoms until it advances.
Several screening tests are available to help detect prostate cancer early. Read on to learn what tests exist, how well they work, and whether you might be a good candidate for prostate cancer screening.
The purpose of screening for prostate cancer is to help detect the cancer before you notice any symptoms. There are multiple screening tests that doctors might use, and often, doctors combine them.
Prostate Cancer: Advancements In Screenings
You may know thatprostate canceris one of the most common cancer types in men. The good news is that thereare many treatment and management options, even if the cancer is caught ata later stage.
What you may not know: There are several options when it comes toprostate cancer screening. After considering multiple factors, your doctor may recommend theprostate-specific antigen test, and/or one of the newer screeningtests that are now available.
Johns Hopkins urologistChristian Pavlovich, M.D., explains what you should know.
Don’t Miss: After Prostate Removal What To Expect
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11, 18F-DCFPyl , and Ga 68 gozetotide , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body. PSMA PET scans can also be used to help determine if the cancer can be treated with a radiopharmaceutical that targets PSMA.
Doctors are still learning about the best ways to use these newer types of PET scans, and some of them might not be available yet in all imaging centers.
Screening Prostate Cancer With Blood And Urine Tests
David Albala, MD: A variety of other tests have been commercially available for example, the Prostate Health Index and the 4Kscore. These are blood tests. And weve seen an explosion in the last couple of years with urine-based tests, like SelectMDx, the PCA3 testwhich has been around for quite some timeand now exosome ExoDx is the new kid on the block. Lets say Im a urologist just starting my career. I have a variety of choices. How do you try to pick 1 test vs another, and how do you use those in combination with the PSA test and the rectal exam that weve traditionally been taught to do?
Judd W. Moul, MD: Thats a great question. Thats a lot of information to cover. Let me back up and say that if Im a urologist starting in practice, 1 thing that weve seenor that Ive seen in my 30 years doing thisis that many patients are more sophisticated. When theyre presented with an elevated PSA, especially a borderline PSA or a gray zone PSA, many patients want more data before theyre willing to undergo an invasive biopsy. So if Im starting in practice, Id want to be comfortable with some of the secondary tests that could be done between an elevated PSA and a biopsy.
Transcript edited for clarity.
Don’t Miss: Enlarged Prostate Blood In Urine
How The New Urine Test Works
The research team used machine learning to assess gene expression in urine samples collected from 537 men.
When they looked at the cell-free expression of 167 genes in urine samples, they found a mathematical combination of 35 different genes that could be used to produce the PUR risk signatures.
The new test uses four PUR signatures to assess noncancerous tissue and risk groups, which lets doctors know if a person is at low-, intermediate-, or high-risk.
The PUR test measures the expression of approximately 30 genes in urine and gauges the rate at which certain functional units in the cell are being produced.
From there, the tests create a score. If this score is high, the man will need treatment sooner. If its low, the man will need treatment later, or might not need treatment at all, explained Daniel Brewer, PhD, a senior lecturer at the University of East Anglia and one of the studys researchers.
Doctors have challenges when it comes to classifying which tumors will become more aggressive.
This makes it more difficult to determine appropriate treatments.
To detect prostate cancer, doctors commonly use the prostate-specific antigen blood test or a physical test known as a digital rectal examination, a magnetic resonance imaging scan, or a biopsy.
The PSA test is the standard assessment, but about 75 percent of men with an elevated PSA level wind up having biopsies but no cancer, the researchers noted in their study.
Urologic Cancer Management Platform
Our Disease Management Platform⢠uses precise biologic information interrogation techniques to categorize patients into one of four groups: no molecular evidence of prostate cancer, low-risk cancer, intermediate-risk cancer, or high-risk cancer.
This gives physicians the ability to clearly determine which patients need treatment and which can be safely and non-invasively monitored, helping avoid harmful and costly overtreatment.
Our highly accurate, easy-to-administer urine tests are powered by our algorithm-based Disease Management Platform⢠to help physicians diagnose and monitor patients across the continuum of cancer care for optimal case management and prioritization.
You May Like: Pictures Of Radiation Treatment For Prostate Cancer