Researchers at the University of East Anglia (UEA) have shown that a prostate cancer urine test can identify men at intermediate risk who can safely avoid immediate treatment and benefit from active surveillance instead.

A new pilot study published in the journal Life reveals how urine biomarkers can show the amount of significant cancer in a prostate, highlighting with more certainty which men need treatment.

Previously, the team’s prostate urine risk (PUR) test could identify men with high- and low-risk cancers. Now, thanks to some fine-tuning, it also can help men with intermediate-risk disease—for whom treatment options had been less clear.

Prostate cancer is the most common cancer in men in the United Kingdom. It usually develops slowly, and the majority of cancers will not require treatment in a man’s lifetime. The most commonly used tests for prostate cancer include blood tests, a physical examination known as a digital rectal examination, an MRI scan, and an invasive biopsy. However, physicians struggle to predict which tumors will progress to a more aggressive form, making it hard to decide on treatment for many men.

“While prostate cancer is responsible for a large proportion of all male cancer deaths, it is more commonly a disease men die with rather than from,” says lead researcher Dr. Jeremy Clark from UEA’s Norwich Medical School. “Therefore, there is a desperate need for improvements in diagnosing and predicting outcomes for prostate cancer patients to minimize overdiagnosis and overtreatment while appropriately treating men with aggressive disease, especially if this can be done without taking an invasive biopsy.”

Prostate Cancer Urine Test Manages Intermediate Risk Patients

According to Clark, half of men diagnosed with prostate cancer are classified as “intermediate risk,” and the treatment pathways available for these patients traditionally have been less clear. The PUR test will now be able to provide physicians with more clarity by helping to identify and monitor patients in this group.

“It is known that disease progression in intermediate-risk men is associated with the presence of increasing amounts of Gleason pattern 4 cancer in their prostate,” Clark says. “Our study shows that the PUR test can assess the amount of Gleason pattern 4 without the need for a biopsy. So not only can PUR measure the presence of aggressive cancer, but it can also measure increasing amounts of aggressive cancer in a prostate. This means that it can show us which men at intermediate risk may require treatment and which may instead be managed conservatively with surveillance.”

For those patients who do not require immediate intervention, the prostate cancer urine test can be used as an observational tool.

“PUR will also be useful for monitoring disease in men that do not currently require treatment and flag up the emergence and expansion of aggressive disease,” Clark notes.

The results of this pilot study will be further investigated in a much larger cohort of men using samples collected with a prostate screening box. The patients both receive the box and return the samples by mail, and then the samples are analyzed at UEA.

“In this research, we examine in more detail what biological change PUR is detecting. This is an exciting finding that helps explain why PUR works so well,” says Daniel Brewer, PhD, also from UEA’s Norwich Medical School and a visiting worker at the Earlham Institute. “This test is currently being validated in a large multiple site study supported by Prostate Cancer UK and Movember.”

 A charity dedicated to men’s health causes, Movember is best known for its signature mustache-growing competition during the month of November, which helps raise money for prostate and testicular cancer research.

“This new research from Dr. Clark’s team shows that the PUR test can be used to estimate the level of a specific pathological characteristic (Gleason Pattern 4) that is linked to increased risk of disease progression in men with prostate cancer,” says Sarah Hsiao, PhD, director of biomedical research and impact at Movember. “This is important because, for men whose prostate tumor contains varying levels of Gleason Pattern 4, a prostate biopsy is necessary to determine whether men should receive active treatment or be managed by active surveillance. 

“We look forward to seeing further validation of this research in a larger study cohort,” she adds. “If successful, this noninvasive PUR test may be able to support decision-making process without needing an invasive prostate biopsy that is associated with discomfort and risk of infection.”

This study was led by UEA in collaboration with researchers in the Urology and Cellular Pathology departments at the Norfolk and Norwich University Hospital, Hull University Teaching Hospitals NHS Trust, the Institute of Cancer Research, The Royal Marsden, and the Earlham Institute.

It was funded by Movember, Prostate Cancer UK, the Masonic Charitable Foundation, the Bob Champion Cancer Trust, Big C, the King family, the Andy Ripley Memorial Fund, the Hargrave Foundation, the Provincial Grand Lodge of Norfolk, and the Tesco Centenary Grant.