A new pilot study concludes that at-home urine tests could make prostate cancer diagnoses shorter, simpler, and possibly even more accurate.
Prostate cancer is common, affecting nearly half of males over 50. However, it tends to develop slowly, and in many cases, health professionals do not consider it clinically significant. In other words, it is not likely to shorten the male’s life.
This poses a real problem for medical professionals, as it becomes difficult to know who to treat and when. On the one hand, it is important not to begin treatment if someone does not need it, but on the other hand, they must make sure that someone who is likely to develop aggressive prostate cancer receives the best care.
Currently, the two most common diagnostic tools are digital rectal exams and blood tests for prostate-specific antigen (PSA). Although PSA is useful, there are issues. The National Cancer Institute provide an example:
“[O]nly about 25% of men who have a prostate biopsy due to an elevated PSA level actually are found to have prostate cancer when a biopsy is done.”
For this reason and others, researchers are investigating other ways of testing for prostate cancer, and some are looking to urine.
Prostate urine risk tests
As fluid moves from the prostate through the urethra, it carries cancer cells and RNA with it. Once the body has passed this genetic and cellular information out in the urine, scientists can use it to detect clues about the presence of prostate cancer.
These tests are called prostate urine risk (PUR) tests, and studies have demonstrated that they can help predict whether or not prostate cancer will become aggressive.
In earlier studies of PUR tests, before researchers collected a urine sample, they conducted a digital rectal exam. As the authors of the new study explain, during the exam, a doctor will “firmly stroke” one side of the prostate. This encourages cellular and genetic material to move from the prostate to the urine sample.
Digital rectal exams are unpopular and require a trip to the doctor’s office. Researchers from the University of East Anglia in the United Kingdom wanted to determine whether or not it would be possible to skip this procedure while still yielding accurate PUR results.
Their recent study investigated an at-home version of the PUR test. At-home testing allows participants to take a urine sample at home and mail it to the laboratory. This is ideal, because it means that the person can capture the first urination of the day.
As lead researcher Dr. Jeremy Clark explains, “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.”
A simpler methodology
To investigate whether or not this home-based approach might be viable, the scientists recruited 14 participants. Each used an at-home urine sampling kit to collect the first urination of the day. They also provided a sample 1 hour after their first urination and another after a digital rectal examination in the clinic (on a different day). This allowed the scientists to compare the results.
They have recently published their findings in the journal BioTechniques.
“We found that the urine samples taken at home showed the biomarkers for prostate cancer much more clearly than after a rectal examination,” explains Dr. Clark, “And feedback from the participants showed that the at-home test was preferable.”
The study authors now believe that the at-home PUR test could make a substantial difference in the diagnosis of prostate cancer. Dr. Clark explains that, in the future, it could “revolutionize how those on ‘active surveillance’ are monitored for disease progression.”
Currently, these males must visit a clinic once every 6–12 months, where they undergo painful biopsies. This new method would mean that they only need to mail a urine sample to the laboratory.
“It means that men would not have to undergo a digital rectal examination, so it would be much less stressful and should result in a lot more patients being tested.”
– Dr. Jeremy Clark
The University of East Anglia researchers designed this new study to test the efficacy of at-home urine collection. Now they know that this methodology works, they plan to use it more widely to investigate aggressive prostate cancer in the near future.
The study authors believe that this protocol might also be useful when “screening for other urinary cancers, such as bladder and kidney.” Because the process is simple and cost effective, it will speed up clinical trials studying prostate cancer and make it easier to recruit a greater numbers of participants.