Urine Testing to Diagnose Prostate Cancer?

PSA screening has been the baseline tool for evaluating prostate cancer (PC) for years. However, the PSA test, which measures serum levels of prostate-specific antigen, is not sufficient by itself as a diagnostic tool for prostate cancer. Serum PSA levels cannot distinguish between actual cancer and non-cancerous benign conditions like BPH, or other conditions that cause inflammation of the prostate, which can cause elevated protein levels. Thus, many men with elevated PSA do not have, and won’t necessarily develop prostate cancer. However, researchers are working to develop new tests that are designed to provide more specific information to better guide the treatment decision-making process.

Is there a urine test for prostate cancer?

At the University of Michigan researchers have been working to develop more accurate urine tests. They are looking for biomarkers, as researchers do in other cancers, in order to develop better predictors of prostate cancer. Since 2013, the urine test known as MiPS (Michigan Prostate Score), measures PSA levels along with T2:ERG and PCA3, molecular RNA markers which when combined provide credible indications to physicians on individual risk of developing prostate cancer.3

MiPS results – how they work

Evaluating MiPS tests should provide doctors with improved and more substantial, personalized test results. The new test looks for the fusion of 2 genes on chromosome 21: T2 and ERG. The findings suggest that the gene fusion is a trigger to turn on prostate cancer. Fusion of T2:ERG and PCA3 levels in their urine correlate with low, intermediate and high levels (or scores) which translate to cancer risk. T2:ERG is present in about half of all prostate cancers while PCA3 is present at higher levels in 95% of prostate cancer cases.

Individualized diagnosis

The European Urology journal published study results revealing that MiPS scores could be used as part of the diagnostic criteria to determine if biopsy is appropriate for each individual case. The study looked at nearly 2,000 cases. It evaluated individual biomarkers and combinations of biomarkers to predict the likelihood of prostate cancer as well as the risk for aggressive, high-risk prostate cancer.4

Using this tool, the number of biopsies could be reduced by about one-third, and it could also help limit the impact of the delayed diagnosis of high-risk prostate cancers to about one percent of men.

Reducing biopsies and improving treatment

These improved urine tests have reduced the number of biopsies used to check for prostate cancer. Prior research has shown that up to 40% of biopsies are conducted because of elevated PSA levels; yet show no cancer cells or indolent cells upon further examination.2 Indolent cancer cells, those that are painless or very slow growing, are typically not life-threatening. Improved understanding of prostate cancer biomarkers can better target who should receive immediate treatment. Fewer biopsies may result in fewer early surgical treatments, which can result in adverse side effects.

With better diagnostic tools, a man’s healthcare team can better guide patient-specific treatment recommendations and match them with an individualized risk assessment.4 With improved screening tools, such as this more specific uring test, men can be better informed when making treatment decisions. As a result, on the whole, healthcare providers can reduce the number of unnecessary biopsies, and better tailor surgery and other treatment options.

View References
  1. Urine test accurately diagnoses prostate cancer. Harvard Medical School, Harvard Health Publications reviewed March 2, 2011. https://www.harvardprostateknowledge.org/urine-test-accurately-diagnoses-prostate-cancer. Accessed online January 31, 2018.
  2. New Urine test for prostate cancer available, unlike PSA test, is ultra specific for prostate cancer. Prostate Cancer Foundation website. Published September 25, 2013. https://www.pcf.org/news/new-urine-test-for-prostate-cancer-available-unlike-psa-test-is-ultra-specific-for-prostate-cancer/. Accessed online January 31, 2018.
  3. Can a Urine Test Help Detect Prostate Cancer? Prostate.net website. Published August 3, 201. https://prostate.net/articles/can-a-urine-test-help-detect-prostate-cancer. Accessed online January 31, 2018.
  4. Urine-based test improves on PSA for detecting prostate cancer. Published May 18, 2015. https://www.mcancer.org/news/archive/urine-based-test-improves-psa-detecting-prostate-cancer. Accessed online January 31, 2018.