Urine biomarker spots aggressive prostate cancer

Prostate cancer is very common, but it is often slow growing and symptom-free. So, for many men, the best policy is 'watch and wait'. However, a proportion of prostate cancers turn out to be aggressive, and so a biomarker that could pick out those who need immediate treatment could save lives and help avoid unneeded therapies.

As part of the Canary Prostate Active Surveillance Study, researchers analyzed urine samples from 401 men with prostate cancer. They linked the urine biomarkers PCA3 (a non-coding stretch of RNA) and TMPRSS2-ERG (two genes fused together) with larger tumors or higher Gleason scores (an indication of more aggressive cancer). The results were presented at the 2012 Genitourinary Cancers Symposium of the American Society of Clinical Oncology.

"Prostate biopsies are invasive and don't always pick up all of the cancer. Post-digital-rectal exam urine collection is much less invasive. If a urine-based diagnostic test could be developed that could help predict aggressive disease or disease progression, that would be ideal," said principal investigator Daniel Lin of the Hutchinson Center and the University of Washington. "The ultimate goal is that men on active surveillance could use a test based on these biomarkers or others to complement biopsy and PSA data to indicate or rule out the presence of an undetected aggressive cancer or future development of aggressive cancer."

Prostate biopsies are unpleasant and distressing, and some men have to undergo repeated biopsies as their cancer is under active surveillance (watchful waiting). Replacing (or supporting) them with a simple urine test would improve quality of life and reduce uncertainty for men who are watched rather than treated, and could cut costs for healthcare providers by reducing the need for invasive diagnostics, as well as ensuring the right treatment goes to the right people. The study is ongoing and the researchers intend to enroll 1,000 men and monitor then for 5 years, looking at changes in biomarkers over time, and linking the biomarkers with disease progression.

- read the press release
- see the abstract

Special Report: Five Prostate Cancer Diagnostics to Watch