How effective is the urine test for prostate cancer? It’s been available for about a year now. Is it working?
By Deborah Jeanne Sergeant
After receiving a diagnosis of prostate cancer, men and their healthcare providers have many decisions to make together.
Prostate cancer treatment can result in urinary incontinence and impotence, and since many prostate cancers are slow-growing, a man may be a good candidate for active surveillance, depending upon many factors such as comorbidities, age and ethnicity.
Other than periodic check-ups to ensure the cancer isn’t growing, he may not require further treatment.
Historically, testing has involved a prostate specific antigen (PSA) blood test, digital rectal exam and biopsies to determine if their cancer is growing. Understandably, prostate cancer patients don’t like the invasive tests.
About a year ago, researchers in the UK announced a new prostate urine risk (PUR) test that may help test risk of their cancer becoming more aggressive. The trial included 500 men, most of whom had prostate cancer. It was able to detect men who are up to eight times less likely to need radical treatment within five years.
“People don’t know about it and even most urologists don’t know about them,” said physician John Rutkowski at UBMD Urology. “It’s an interesting idea, but there’s a lot of work that needs to be done for validating these ideas.”
The test looked at the biosignature or genetic profile of patients and found 36 genes that enabled them to determine risk.
Rutkowski estimates the PUR test likely won’t be available for five years or so.
A blood or urine test is much less invasive than biopsy. The PSA blood test also gives false results — both negative and positive — so something more accurate that could prevent the need for a biopsy would benefit patients.
Rutkowski encourages men with prostate cancer to discuss all the options available. He said that a problem with the PSA blood test is that it’s not specific to prostate cancer as any number of health factors could elevate a man’s PSA without reflecting the presence of cancer or the aggressiveness of an existing cancer.
The US Preventive Task Force has questioned the benefit of the PSA a few years ago because of false results; however, it has since said it offers some merit and it remains part of the ways urologists test for and manage prostate cancer.
Prostate MRI is being used more than ever with diagnosed men, as biopsies can be painful and cause infection. MRI can also guide biopsy if providers see something that looks like cancer.
Physicians can use MRI to focus radiation therapy on that focal point instead of treating the entire prostate.
A newer tool in the urologist’s toolbox is the 4-K blood test, which tests a few molecular variations of the PSA and uses a formula that includes biopsy history, age and other factors to give a number indicating risk.
John DeBerry, III, a board-certified urologist practicing in Buffalo, is also interested in the PUR test.
“I think that it might be very useful, but it will depend upon different studies looking at it in a wider cross section of patients,” DeBerry said.
He is also making use of MRI to “hone in on the higher risk cancer,” he said. “We have a higher yield of clinically significant cancer present and we can repeat MRI imaging for monitoring.”
Health insurance typically covers annual prostate MRI for patients with a negative biopsy and elevated PSA or those diagnosed with cancer and are on active surveillance.
“It doesn’t usually cover a screening MRI for someone with an elevated PSA but no biopsy,” DeBerry said.