New prostate cancer test identifies men at intermediate risk

A new type of test, developed by Movember-funded researchers, may be able to determine which men with ‘intermediate risk’ prostate cancer can safely avoid immediate treatment and opt for active surveillance.

A pilot study published by a team at the University of East Anglia*, has revealed how urine biomarkers can estimate the significance of prostate cancer cells and identify with more certainty which men need immediate treatment such as surgery or hormone therapy.

The team at the University of East Anglia has previously shown that the Prostate Urine Risk (PUR) test could distinguish men with high and low risk cancers – but thanks to some fine-tuning, it can now help men with intermediate-risk disease for whom treatment options had been less clear.

Globally, prostate cancer is the most common cancer in men – around 1.4million men worldwide were diagnosed last year. It usually develops slowly, and most cancers will not require treatment in a man’s lifetime.

However, doctors struggle to predict which tumours will progress to a more aggressive form, making it hard to decide on treatment for many men.

Lead researcher Dr Jeremy Clark, from UEA’s Norwich Medical School, said: “There is a desperate need for improvements in diagnosing and predicting outcomes for prostate cancer patients to minimise over-diagnosis and overtreatment whilst appropriately treating men with aggressive disease, especially if this can be done without taking an invasive biopsy.

“Previously we have shown that PUR can identify men with high-risk cancer which requires immediate treatment and low-risk cancer that has a very low rate of progression and does not generally need treatment.

“But there is a third category of men with ‘intermediate-risk’. Around half of men diagnosed with prostate cancer fall into this group and the treatment pathways for them have been less clear, until now.”

Disease progression in intermediate-risk men is associated with the presence of increasing amounts of Gleason pattern 4 cancer in the prostate. The new study shows that the PUR test can assess the amount of Gleason pattern 4 without the need for a biopsy.

Dr Clark added: “This means that it can show us which men at intermediate risk may require treatment and which may instead be managed conservatively with surveillance.

“PUR will also be useful for monitoring disease in men that do not currently require treatment and flag up the emergence and expansion of aggressive disease.”

The results of this pilot study will be further investigated in a much larger group of men.

Dr Sarah Hsiao, Director, Biomedical Research and Impact at Movember, said: “We’re looking forward to seeing further validation of this research in a larger study cohort.

“If successful, this non-invasive PUR test may be able to support decision-making process without needing an invasive prostate biopsy that is associated with discomfort and risk of infection.”

*The Urine Biomarker PUR-4 is Positively Associated with the Amount of Gleason 4 in Human Prostate Cancers’ is published in the journal Life (MDPI) on November 3, 2021