Prostate cancer is a common form of cancer diagnosed in men across the globe, second only to lung cancer1. Traditionally, clinical screening for prostate cancer involves:
- A urine sample
- A blood sample to test the level of prostate-specific antigen (PSA) in the body (i.e. a PSA test)
- A digital rectal examination (DRE) in which a doctor examines the prostate by inserting a gloved, lubricated finger into the patient’s anus.
There is no clear consensus on the age at which prostate screening should begin. Some guidelines dictate that all men should be screened from the age of 45. Others suggest that screening at midlife should be conducted if a man has a family history of prostate cancer or is of African American descent. It is, however generally accepted that screening should begin no later than 55 years of age2.
For most men, the digital rectal examination is considered uncomfortable, embarrassing and invasive3, albeit admittedly a necessary evil in the prevention of cancer. Now, a team of researchers from the University of East Anglia and the Norfolk and Norwich University Hospital, have developed a simple and cost-effective way for men to screen for prostate cancer using only urine samples collected at home. Their study was published today in the journal BioTechniques4.
Introducing the Prostate Urine Risk (PUR) test
The Prostate Urine Risk (PUR) test has been designed to diagnose aggressive prostate cancer. It can predict whether treatment will be required up to five years earlier than the clinical methods currently in use. The test examines gene expression using a man’s first urination of the day, which contains higher, more consistent levels of prostate biomarkers. From the results, doctors can determine whether the type of prostate cancer, if present, is a lower risk or more aggressive form.
As the team’s lead researcher Dr Jeremy Clark points out, knowing this is important. Prostate cancer usually progresses slowly and many sufferers will not require treatment in their lifetime. However, doctors can’t easily predict whether a tumour will become aggressive or not, making it challenging to determine when to proceed with treatment.
The team hopes that their research will lead to the launch of an 'at-home collection kit' that could change the way prostate cancer is screened for and diagnosed.
Similar at-home testing options have taken off when it comes to STD testing, and findings show that people prefer these less invasive and more private options.
The researchers's PUR at-home collection pilot test kit for prostate cancer screening contained:
A) An invitation to participate. B) Study information sheet. C) 2x 30ml tubes for urine collection (containing dried Norgen preservative). D) 2x consent forms (one for the person conducint the test to keep and the other to return with the samples). E) 1x Disposable non-allergenic glove. F) Pen (to record the date and time on the test tubes). G) 1-h frog timer. H) Sealable plastic bag with wadding. I) Pre-addressed, postage-paid SafeBox for returning the samples.
Benefits of the PUR test
According to Clark, men will no longer have to undergo digital rectal examinations. This will not only make testing far less invasive and stressful but also encourage more men to get tested regularly.
Those with negative test results will only need to have follow-up screens every two to three years. This is a prospect Consultant Surgeon in Urology at the Norfolk and Norwich University Hospital, Dr Robert Mills finds very promising. He believes that significant value lies in avoiding putting many men through the stress of unnecessary and often costly investigations.
It also helps medical professionals to cut down on clinical workloads. A factor that is of increasing concern and relevance as medical resources continue to be stretched and burdened by the growing ageing population.
Even if the test is positive for prostate cancer, it helps doctors to differentiate between those who require treatment and those who do not. Only those requiring treatment will undergo active surveillance which may then involve MRI scans and repeat biopsies, practices which some feel are somewhat invasive.
The team also believe that their research may lead to the development of innovative home-collection tests for other forms of cancers, including kidney and bladder related malignancies.
1. Merriel S, Funston G, Hamilton W. Prostate Cancer in Primary Care. Adv Ther. 2018;35(9):1285-1294. doi:1007/s12325-018-0766-1
2. Kohestani K, Chilov M, Carlsson S. Prostate cancer screening—when to start and how to screen?. Transl Androl Urol. 2018;7(1):34-45. doi:21037/tau.2017.12.25
3. James L, Wong G, Craig J et al. Men’s perspectives of prostate cancer screening: A systematic review of qualitative studies. PLoS ONE. 2017;12(11):e0188258. doi:1371/journal.pone.0188258
4. Webb M, Manley K, Olivan M et al. Methodology for the at-home collection of urine samples for prostate cancer detection. BioTechniques. 2019. doi:10.2144/btn-2019-0092