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New urine test could make a “radical” difference to prostate cancer screening

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Prostate cancer

A new prostate cancer urine test shows how aggressive the disease is and could reduce the need for invasive biopsies. Health Tech world talked to one of the scientists behind the new tech to hear about its potential to reduce costs, improve efficiency and eliminate the unnecessary worry that many men with prostate cancer experience


Researchers from the University of East Anglia have developed a new urine test for prostate cancer which has the ability to show how aggressive the disease is.

Prostate cancer is the most commonly diagnosed cancer amongst men in the UK. According to Prostate Cancer UK, one in eight men will be diagnosed with the disease in their lifetime.

Despite the disease’s prevalence, most people will not require treatment in their lifetime and survival rates are high with most estimates falling between 80 and 90 per cent.

A new study published in April shows how an experimental new test called ‘ExoGrail’ has the potential to revolutionise how patients with suspected prostate cancer are risk-assessed prior to an invasive biopsy.

The research team at UEA’s Norwich Medical School say the new test could reduce the number of unnecessary prostate cancer biopsies by 35 per cent.

The normal pathway for getting diagnosed with prostate cancer starts with a PSA measurement which measures markers in the blood. Clinicians may then perform a digital rectal exam or MRI scan before carrying out an invasive biopsy to determine the severity of the disease.

Biopsies are an accurate way to determine the aggressiveness of cancer, however they come with risks of infection, discomfort and, in many cases, undue worry for the patient.

They are also expensive. According to Dr Dan Brewer, the lead researcher on the UEA study, biopsies cost in the region of £500. With the ExoGrail, Dr Brewer said these costs could be shaved down to just £200.

Dr Brewer told Health Tech World: “We’re looking at ways of testing for the presence of aggressive prostate cancer, without having to take the biopsy.

“There is a desperate need for improvements in diagnosing and predicting outcomes for prostate cancer patients to minimise overdiagnosis and overtreatment whilst appropriately treating men with aggressive disease.”

“Invasive biopsies come at a considerable economic, psychological and societal cost to patients and healthcare systems alike.

Dan Brewer Prostate Cancer

Dr Dan Brewer: Lead researcher and group leader within the Cancer Genetics Team, Norwich Medical School

“There is always going to be a need for biopsies because without someone actually looking at the cells, you can never be quite certain. But, I think the approaches we’ve taken here are going to remove the need for lots of patients to have a biopsy, especially the large body of people that have a low-grade form of the disease.”

The research team developed the new ExoGrail urine test by combining two biomarker sources – measurements of a protein-marker called EN2 and the levels of gene expression of 10 genes related to prostate cancer risk. It builds on previously developed tests called PUR and ExoMeth.

They tested the new technique using urine samples from 207 patients who had undergone a biopsy for prostate cancer at the Norfolk and Norwich University Hospital (NNUH).

When the urine results were compared to biopsy results, the study showed that the test had successfully shown which patients had prostate cancer and which did not.

The ExoGrail test also provided risk scores for patients and highlighted those for which an invasive biopsy would have been beneficial.

The findings show that using information from multiple, non-invasive biomarker sources has the potential to improve how patients with suspected prostate cancer are risk-assessed prior to an invasive biopsy.

Dr Brewer said: “Our new urine test not only shows whether a patient has prostate cancer, but it importantly shows how aggressive the disease is. This allows patients and doctors to select the correct treatment. And it has the potential to reduce the number of unnecessary biopsies by 35 per cent.”

Off the back of the study’s success, the research team at UEA have been awarded funding from Prostate Cancer UK and the Movember GAP1 Urine Biomarker project to carry out a three-year follow-up study to validate their findings.

“The project we’re working on at the moment is going to involve different institutions collecting [data] from different types of patients. We’ve got great hopes for the validation study,” Dr Brewer said.

The team have developed a methodology so that patients can now collect a sample at home and send it off for analysis rather than go into the hospital in an effort to minimise patients’ concern for their health.

The next stage following the validation project will be an intervention study, which means clinicians will alter the patient pathway based on the ExoGrail test results.

According to Dr Brewer, the test could be brought into clinical practice in the next three to five years.

“If the clinical community adopts it, I think it could make a radical difference to those men that might not have the aggressive form of the disease.

“If it works really well then it could become a screening strategy.”

A lot of men with prostate cancer progress along a treatment pathway called ‘active surveillance. Instead of having treatment they are checked regularly and have a biopsy every two years.

The problem is that around 50% choose to have treatment anyway even when it is not necessary. Dr Brewer thinks this could be because the regular tests and hospital visits compel patients to believe that they need treatment.

“In most cases, they probably don’t need to do anything about it. But because they’re constantly being tested and going to the hospital, they believe they have to do something about it.

“We hope that this sort of test can be used in that pathway as well. So maybe every year you do the [ExoGrail] test and then that’s it; you don’t have to think about it anymore.

“It will give you more certainty that you don’t need to have additional treatment.”

Although the research is still in its early stages, Dr Brewer believes that similar techniques could potentially be used to diagnose other cancers associated with the urological tract, including kidney and bladder cancer.

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