Testing urine for prostate cancer - the crystal ball in your bladder (2024)

Have you ever felt like you're just waiting for the other shoe to drop, especially regarding medical test results? Francis Collins, former NIH director, found himself in that situation, dancing the delicate tango of active surveillance for prostate cancer. Imagine a urine test that could cut down on those nerve-wracking biopsies while boasting a 99% accuracy rate for spotting the serious stuff.

In the past week, Francis Collins, former director of the National Institutes of Health, wrote in the Washington Post about his recent diagnosis of an aggressive form of prostate cancer. Like many men, he was initially diagnosed with a slow-growing “grade” of prostate cancer and has pursued a course of active surveillance – a form of watchful- waiting with routine visits to his physician and testing for PSA, prostate-specific antigen, and biopsies. As he writes,

“Over my 40 years as a physician-scientist, I’ve had the privilege of advising many patients facing serious medical diagnoses. I’ve seen them go through the excruciating experience of waiting for the results of a critical blood test, biopsy, or scan that could dramatically affect their future hopes and dreams. … At first, there wasn’t much to worry about — targeted biopsies identified a slow-growing grade of prostate cancer that doesn’t require treatment and can be tracked via regular checkups, referred to as “active surveillance.”

- Francis Collins, MD

Active surveillance or watchful waiting makes logical sense for a slow-growing tumor, waiting to intervene when the tumor shows signs of going rogue and becoming more aggressive. [1] As Dr. Collins writes,

“Early detection really matters, and when combined with active surveillance can identify the risky cancers like mine, and leave the rest alone.”

What is often less frequently mentioned is the anxiety associated with waiting for results.

Ideally, there would be a diagnostic test that would be safe, accurate, non-invasive, and whose results would be both actionable and timely, providing a benefit. A rising PSA on its ownlacks enough specificity and requires more invasive testing, like a biopsy, or expensive imaging with MRI, specifically multiparametric magnetic resonance imaging or mpMRI. In these screening scenarios, the negative predictive value (NPV) of a test and its accuracy in detecting disease not requiring further evaluation is most valuable. Studies have placed the NPV of mpMRI at detecting more aggressive GG2 cancers at about 77%, with significant variation for centers and reading radiologists. These tests are not always available based on cost and location.

A new non-invasive biomarker, reported in a new study in JAMA Oncology, offers an alternative. There are any number of tests looking at blood or urine for prostate cancer biomarkers. One test of urine, the MPS, marketed as My Prostate Score, used PSA and the expression of two genes associated with prostate cancer to separate the concerning from non-concerning prostate cancers. The new study presents the improved MPS2 version.

The researchers began by searching a large gene panel of patients with prostate cancer for candidate genes associated with high-grade cancers. They identified 54 gene candidates and narrowed that number to a model using 18 genes with and without information on the current prostate size (a very indirect marker of the presence of a tumor). They then obtained urine and biopsy results from a prospective study conducted by the National Cancer Institute’s Early Detection Research Network involving patients undergoing biopsy because of an elevated PSA or abnormal rectal prostate examination. The development group for the new MPS2, 815 patients, had a median age of 63 and PSA of 5.6, which is well above the 95th percentile for this age group, and a 38% incidence of GG2 or greater prostate cancers on biopsy – all real-world numbers.

The validation group involved another 813 patients, median age 62, PSA 5.6, and 20% had GG2 or greater prostate cancers on biopsy. 12.8% were Black, and about a third had previously negative biopsies. The study has limitations, specifically the small percentage of Black patients, given the increased incidence of prostate cancer among Blacks and the population derived from academic centers, both of which make the translation of these results to a more general population imperfect.

Results

Testing urine for prostate cancer - the crystal ball in your bladder (1)The researchers presented the results based on the area under the curve (AUC). The AUC describes how well a test can tell whether someone has a disease or not. A perfect test would have an AUC of 1, indicating perfect discrimination; a completely random test would have an AUC of 0.5, indicating the discrimination of a coin flip. While useful, it does not provide information about the optimal cutoff point and can be influenced by the prevalence of the condition in the population being tested.

For detecting high-grade cancers, the PSA had an AUC of 0.6, the MPS2 0.82 (0.85 when accounting for prostate size). In other terms, its negative predictive value ranged from 95 to 99%. As a more practical measure, overall, using PSA as the threshold for biopsy would have avoided 11% of unnecessary biopsies, and using MPS2 reduced unnecessary biopsies by 37% (41% when accounting for prostate size).

In the population undergoing initial biopsy, where the rate of high-grade cancers was 26.8%, MPS2+ (the test accounting for prostate size) reduced the need for biopsy by roughly 40%. For those patients undergoing a repeat biopsy where the incidence of high-grade cancer was much lower, 7.3%, MPS2+ eliminated nearly 50% of biopsies. Those are good screening results for any test, let alone one that involves just peeing into a cup.

As the researchers write,

“For individual patients, NPVs approaching 100% provide clear guidance for confident decision-making. For clinicians, uniform use of MPS2 could avoid unnecessary biopsies while preserving immediate detection of 95% of cancers of GG 2 or greater diagnosed using the biopsy all approach. Critically, MPS2 had 99% sensitivity and 99 %NPV for cancers of GG 3 or greater, meaning the rare false-negative.”

[1] Prostate cancers are graded based on their pathologic appearance using the Gleason scale. A Gleason score of 6 or less is considered to be indolent enough to allow for active surveillance. Gleason scores of 7 or more reflect aggressive tumors that require intervention. These tumors are called Grade Group 2.

Source: Development and Validation of an 18-Gene Urine Test for High-Grade Prostate Cancer JAMA Oncology DOI: 10.1001/jamaoncol.2024.045501/jamaoncol.2024.0455

Testing urine for prostate cancer - the crystal ball in your bladder (2024)

FAQs

Can you detect prostate cancer from a urine sample? ›

Urine tests: One urine test, EPI, is done using a fresh catch urine specimen. This test can help predict clinically significant prostate cancer in men who have not yet had a biopsy. Another, the PCA3 test, is done after “a vigorous rectal exam,” says Loeb.

What is the marker for prostate cancer in urine? ›

The PCA3 gene is highly specific for prostate cancer and is detectable in prostate cancer cells shed into urine after rectal palpation, compared with BPH tissue.

What is the most reliable test for prostate cancer? ›

A prostate biopsy is one of the most accurate ways to diagnose prostate cancer.

What is the new test for prostate cancer? ›

TRANSFORM will test new screening approaches with the potential to greatly improve early detection and treatment pathways. With over 12,000 prostate cancer deaths in the UK, this could mean thousands of men saved each year, and many thousands more worldwide.

Can a urine dipstick test detect cancer? ›

Conclusion: Dipstick urinalysis provides a highly specific test for microhematuria and similar accuracy to microscopic urinalysis when used as a diagnostic tool to detect bladder cancer.

Can you pee normal with prostate cancer? ›

Urinary problems caused by prostate cancer

This could include trouble getting started (urinary hesitancy), incomplete emptying, or a weak urine stream.

What are two markers for prostate cancer? ›

RT-PCR is extremely sensitivity in detecting tissue-specific mRNA of tumor markers such, as PSA (45), hK2 (46), and more recently, prostate-specific membrane antigen (PSMA). PSMA is a 100-kDa transmembrane glycoprotein identified in all types of prostatic tissue, but particularly elevated in carcinomas.

What are cancer markers in urine? ›

Urine tumor marker (biomarker) tests

BTA tests: These tests look for a substance called bladder tumor antigen (BTA), also known as CFHrp, in the urine. ImmunoCyt: This test looks at cells in the urine for the presence of substances such as mucin and carcinoembryonic antigen (CEA), which are often found on cancer cells.

Why is PSA no longer recommended? ›

PSA tests aren't foolproof. It's possible for your PSA levels to be elevated when cancer isn't present, and to not be elevated when cancer is present.

What are the three tests for prostate cancer? ›

Tests for prostate cancer
  • a digital rectal examination.
  • a PSA blood test.
  • scans.
  • taking a sample of your prostate gland called a biopsy.
Apr 7, 2022

Does ejacul*ting lower your PSA? ›

sem*n released during sexual activity can cause PSA levels to rise temporarily, which may affect the test results.

What is the best thing to drink for your prostate? ›

Besides teas, other drinks can help improve overall prostate health and potentially reduce symptoms of BPH:
  • Water. Staying hydrated is crucial for overall good health, including that of the prostate.
  • Tomato juice. Tomatoes are a good source of lycopene. ...
  • Citrus juice. Citrus fruits are a great source of vitamin C.
Nov 16, 2021

What PSA level is aggressive prostate cancer? ›

Prostate cancer is determined to be high risk if it is distinguished by any of the following characteristics: A larger primary tumor (greater than or equal to 4.1 to 6 cm, the size of a stage T3 tumor) A prostate-specific antigen (PSA) blood test result higher than 20.

Is a PSA of 30 high? ›

CONCLUSIONS: Serum PSA >30 ng/ml is an almost certain predictor of the presence of prostate cancer. Aggressive prostate cancer education and screening programs are needed in our inner cities in order to detect prostate cancer at an earlier, treatable stage.

What cancers show up in a urine test? ›

It's very helpful when patients give permission for us to use their urine for research.” Bladder cancer is perhaps the most obvious cancer to find in urine, but evidence suggests that remnants of other cancers – like kidney, prostate and cervical cancer – can also get into pee.

What is the easiest way to check for prostate cancer? ›

A blood test called a prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

What are the two ways to detect prostate cancer? ›

Screening options for prostate cancer

Prostate cancer can often be found early by testing for prostate-specific antigen (PSA) levels in a man's blood. Another way to find prostate cancer is the digital rectal exam (DRE). For a DRE, the doctor puts a gloved, lubricated finger into the rectum to feel the prostate gland.

Can a urine test detect an enlarged prostate? ›

Urine flow test

You'll be asked to urinate into a machine that measures the speed of your urine flow. Men with an enlarged prostate usually have a slower flow than other men. You'll need a full bladder for the test. The doctor or nurse will tell you how much to drink before you have the test.

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