02 Dec Home Urine Test May Predict Aggressive Prostate Cancer Prior to Biopsy
MedicalResearch.com Interview with:
Dr Jeremy Clark
University of East Anglia
Norwich Medical School
MedicalResearch.com: What is the background for this study?
Response: Earlier this year we published our pilot study which showed how useful we have found urine to be for diagnosing prostate cancer and predicting which cancers will get bigger and nastier up to 5 years later (Connell et al 2019). – Our PUR (Prostate Urine Risk) signatures separated men with low-risk cancer into two groups one of which had 8-times the rate of future development of aggressive cancer that the other. There is nothing in clinical use at present that can do this.
The new development is our At-Home Urine collection system which means that we can now send out a urine collection kit to a man at home, he fills up a small pot with his first wee of the day and posts it back to us for PUR analysis. This makes the whole system so much less stressful for the patient.
The idea behind it is as follows: the prostate lays just below the bladder, it is a secretory organ and these secretions carry cells and molecules from all over the prostate to the urethra which then get flushed out of the body on urination. If a cancer is present then tiny bits of the tumour are also carried with the secretions and we can detect these in the urine. As the prostate is constantly secreting the levels of biomarkers in the urethra will build up with time. Collecting from the first wee of the day means that overnight secretions can be collected which makes the analysis more sensitive and more robust.
MedicalResearch.com: What are the main findings?
Response: Before the At-Home kit, men would turn up at the hospital, nerves would inevitably mean that they would have a wee before they saw the doctor, and all the secretions would be flushed away. To get around this, urine was collected after a Digital Rectal Examination of the prostate in the clinic whereby the doctor would stroke the prostate with her finger pushing prostate secretions into the urethra shortly before urination. The patients really don’t like this examination and the feedback we have had from the AT-Home Collection kit has been really positive.
MedicalResearch.com: What should readers take away from your report?
Response: The At-Home Collection part sounds like quite a small innovation, but it means that in future the monitoring of cancer in men could be so much less stressful for the patient and reduce the number of expensive trips to the hospital.
Initially we hope that PUR and the At-Home Collection system will be used to identify which men will require a biopsy or MRI. It also has a place in monitoring men on Active Surveillance – these are men who have cancer but it is a low grade which is unlikely to metastasize and kill the patient. Currently these patients are monitored by multiple repeat PSA tests, biopsies and MRI – expensive and highly stressful for the patient. If our current validation trial confirms our earlier results then a urine test could provide men with a way off of this merry-go-round of testing or to triage men to larger gaps between retesting, possibly up to 5 years.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We have just been refunded for the next stage of development of the At-Home collection PUR test by a Movember and Prostate Cancer UK Innovation award – This is a validation study to confirm the findings of the earlier pilot study – a very important step in the progression towards clinical implementation – it’s also an expansion, with samples being collected from ~1500 men from 3 sites in the UK and 7 sites in Europe, the US and Canada.
The At-Home urine test system could also be redirected for use for detection of bladder and urine disease by using different gene probes in the expression analysis.
Martyn Webb, Kate Manley, Mireia Olivan, Ingrid Guldvik, Malgorzata Palczynska, Rachel Hurst, Shea P Connell, Ian G Mills, Daniel S Brewer, Robert Mills, Colin S Cooper, Jeremy Clark. Methodology for the at-home collection of urine samples for prostate cancer detection. BioTechniques, 2019; DOI: 10.2144/btn-2019-0092
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