Male doctor discussing reports with patient at desk in medical office

Home urine test could ‘revolutionise’ prostate cancer diagnosis

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Scientists have been developing a new prostate cancer test – which involves collecting a urine sample at home – that could ‘revolutionise’ diagnoses for thousands of men and spell the end of rectal exams.

Currently there is no single definitive test for prostate cancer; however, the NHS says a GP is likely to take a blood sample to look for antigens or perform a rectal examination, or even an MRI scan, which it says can cause “unnecessary anxiety” and stress in men.

The test being developed by the University of East Anglia (UEA) and the Norfolk and Norwich University Hospital, known as the Prostate Urine Risk (PUR) test, allows men to avoid these rectal examinations as the test can be done in the comfort of their own home.

Around 48,000 men are diagnosed with prostate cancer each year in the UK, and more than 11,000 die from it. The team behind the PUR test say the new development is an important step towards getting more men tested.

“Prostate cancer is the most common cancer in men in the UK. It usually develops slowly and the majority of cancers will not require treatment in a man’s lifetime. However, doctors struggle to predict which tumours will become aggressive, making it hard to decide on treatment for many men,” said lead researcher Dr Jeremy Clark, from UEA’s Norwich Medical School.

“The most commonly used tests for prostate cancer include blood tests, a physical examination known as a digital rectal examination (DRE), an MRI scan or a biopsy.”

According to the team, it will be used for men who are suspected of having prostate cancer and has the ability to pick up how aggressive the disease is and at what point men will need treatment, as well as ruling out those who do not have the disease.

“We developed the PUR test, which looks at gene expression in urine samples and provides vital information about whether a cancer is aggressive or ‘low risk’,” Clark added.

“Because the prostate is constantly secreting, the collection of urine from men’s first urination of the day means that the biomarker levels from the prostate are much higher and more consistent, so this is a great improvement.”

The test is also suitable for men already diagnosed with low-risk disease who are on a “watch and wait” approach known as active surveillance. And for these men, the test could cut follow-up appointments from once every year to once every two to three years.

The research team provided 14 participants with an at-home collection kit, and instructions. They then compared the results of their home urine samples, taken first thing in the morning, with samples collected after a digital rectal examination.

Dr Clark added: “We found that the urine samples taken at home showed the biomarkers for prostate cancer much more clearly than after a rectal examination. And feedback from the participants showed that the at-home test was preferable.

“Using our At Home test could in future revolutionise how those on ‘active surveillance’ are monitored for disease progression, with men only having to visit the clinic for a positive urine result. This is in contrast to the current situation where men are recalled to the clinic every six to 12 months for painful and expensive biopsies.

“Because the PUR test accurately predicts aggressive prostate cancer, and predicts whether patients will require treatment up to five years earlier than standard clinical methods – it means that a negative test could enable men to only be retested every two to three years, relieving stress to the patient and reducing hospital workload.”

The Norfolk and Norwich University Hospital receives more than 800 referrals a year to investigate and treat potential prostate cancers. Prostate cancer usually develops slowly and the majority of cancers will not require treatment in a man’s lifetime.

Robert Mills, a consultant surgeon in urology at the Norfolk and Norwich University Hospital, said: “This is a very exciting development as this test gives us the possibility of differentiating those who do from those who do not have prostate cancer, so avoiding putting a lot of men through unnecessary investigations.

“When we do diagnose prostate cancer, the urine test has the potential to differentiate those who need to have treatment from those who do not need treatment, which would be invaluable.

“These patients go on to an active surveillance programme following the diagnosis which may involve repeat biopsies and MRI scans which is quite intrusive. This urine test has the potential to tell us whether we needed to intervene with these patients.”

‘Methodology for the At-Home Collection of Urine Samples for Prostate Cancer Detection’ is published in the journal BioTechniques.

Earlier this month, a team of scientists from the University of Wisconsin-Madison and the Morgridge Institute for Research said they are in the process of developing a “smart toilet” which monitors the contents of a user’s urine to detect health problems.

In October 2018, researchers from the University of Portsmouth developed a robot as the new ‘weapon of choice’ to detect and treat the most common cancer in men. 

Also, back in 2016, researchers from the Department of Surgery and Cancer at Imperial College London developed a robotic rectum which consists of prosthetic buttocks and a robotic interior. They said the technology may help doctors and nurses boost their ability to detect prostate cancer.

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