Can Urine Test Be The New Non
Researchers have recently found that urine tests could be an extremely accurate non-invasive method to detecting aggressive prostate cancer with few false negatives.
The test is a possible way to avoid of unnecessary prostate cancer biopsies that fail to detect a small number of cancers, according to a validation study of about 1,500 patients.
Can A Urine Test Detect Bladder Cancer
Several types of urine test have an important role in the overall process of diagnosing bladder cancer. Among these tests, urine cytology and urine tumor marker tests are used to detect the presence or absence of bladder cancer. Urine cytology has been used to assist bladder cancer diagnosis for over 75 years and has well-established strengths and limitations which are discussed in more detail below. Molecular tumor marker tests such as Cxbladder have been more recently developed, and provide high diagnostic accuracy in both detection and rule-out.
Notably, no single test is best able to detect bladder cancer, and usually different types of tests are used in combination. For example, the Cxbladder genomic urine test in combination with ultrasound or computed tomography imaging has been shown to identify the presence or absence of bladder cancer with high accuracy in patients with hematuria. The specific diagnostic tests selected depend on several factors, including a patients symptoms and their risk for bladder cancer.
Urine Test Might Dictate Prostate Cancer Treatment
WEDNESDAY, June 26, 2019 — A man who learns he has prostate cancer faces a difficult choice: whether to immediately treat the cancer despite potential side effects or wait and see if it’s a slow-growing tumor that never needs treatment.
Men may soon have help making that decision.
Researchers from the United Kingdom report that they’ve created a urine test that can predict the aggressiveness of a prostate cancer far sooner than standard methods.
The new test is called the prostate urine risk test, or PUR. The researchers said it spots men who are up to eight times less likely to need radical treatment within five years of diagnosis. PUR also offers clues about who might need treatment five years sooner than current tests.
Dr. Durado Brooks is vice president of cancer control interventions for the American Cancer Society. He wasn’t involved in the current research, but said the study was “really intriguing.”
“Anything that helps us predict who will have more progressive disease, or who will be less likely to progress, would be helpful,” he said. “And, it appears, based on a modest sample size, that this tool may offer some promise.”
Prostate cancer typically grows slowly and may never need treatment in a man’s lifetime. However, predicting which men do need treatment isn’t easy.
These invasive procedures and constant reminders that they have cancer leads many men to choose treatment, even if they’re not sure they need it, the researchers explained.
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How Are Samples Collected
Requirements for urine sampling vary depending on the test/s being performed. Often the timing of collection is random, as dictated by the logistics of a doctor consult or access to a laboratory service. However, depending on the purpose of the test, certain urine voids of the day may be preferred. Collection of urine from all voids over a defined time period or sample collection at specific times after eating may also be necessary.
Urine samples are usually obtained by spontaneous voiding, using the clean-catch, midstream urine collection method. This involves voiding the first portion of urine into the toilet, collecting the midstream portion into a clean container, then voiding the remaining portion into the toilet. This method greatly reduces the risk of contaminants entering the sample. Less commonly, an invasive method of urine collection, such as placement of a urinary catheter, may be required.
Learn about Cxbladder’s easy-to-use in-home sampling system
How The New Urine Test Works
The research team used machine learning to assess gene expression in urine samples collected from 537 men.
When they looked at the cell-free expression of 167 genes in urine samples, they found a mathematical combination of 35 different genes that could be used to produce the PUR risk signatures.
The new test uses four PUR signatures to assess noncancerous tissue and risk groups, which lets doctors know if a person is at low-, intermediate-, or high-risk.
The PUR test measures the expression of approximately 30 genes in urine and gauges the rate at which certain functional units in the cell are being produced.
From there, the tests create a score. If this score is high, the man will need treatment sooner. If its low, the man will need treatment later, or might not need treatment at all, explained Daniel Brewer, PhD, a senior lecturer at the University of East Anglia and one of the studys researchers.
Doctors have challenges when it comes to classifying which tumors will become more aggressive.
This makes it more difficult to determine appropriate treatments.
To detect prostate cancer, doctors commonly use the prostate-specific antigen blood test or a physical test known as a digital rectal examination, a magnetic resonance imaging scan, or a biopsy.
The PSA test is the standard assessment, but about 75 percent of men with an elevated PSA level wind up having biopsies but no cancer, the researchers noted in their study.
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Can A Home Or Office Urine Test Replace Traditional Biopsy
For men who have an elevated prostate-specific antigen score on initial screening, poor compliance with physician recommended-biopsy is a common issue. Many men simply dont keep their biopsy appointments because of the discomfort and potential complications associated with the procedure, and many prostate biopsies are low-grade or benign and perhaps unnecessary.
To help address these issues, Duke urologists are using the ExoDx Prostate Test , an exosome-based urine test that does not require a digital rectal examination. The test analyzes cancer-specific genomic biomarkers found in the urine to produce a score that helps physicians and patients decide if biopsy is necessary.
Judd W. Moul, MD, a urologic oncologist and internationally recognized prostate cancer expert, says that in general, men are not as compliant with their health care as most women. Some men avoid going to the doctor because they dread the rectal exam prostate check, he says. Having a simple urine test as a secondary screen for elevated PSA is very appealing to some men, and anything I can do to improve care is welcome.
How the test works
Exosomes are released by all living cells into biofluids that contain ribonucleic acid , deoxyribonucleic acid , and protein, which are excellent for diagnostic needs, Moul explains. The ExoDx test analyzes a patients biology in real time through a urine sample, searching for three RNA biomarkers that are linked to high-grade prostate cancer.
Who is a candidate?
What Can Be Detected In A Urine Test
Urine testing can assist in diagnosing many different disorders including kidney disease, diabetes, liver disorders, urinary tract infections , and bladder cancer.
Urine samples are routinely examined for physical properties , chemical composition and microscopic appearance . To detect bacteria, urine culture may also be performed, as described later.
Abnormal findings in a urine test can be characteristic of certain disease processes. For instance, persistently elevated protein in urine is a common early sign of chronic kidney disease, high levels of glucose may indicate diabetes, the detection of bacteria is often associated with a UTI, and the presence of red blood cells or abnormal cells may indicate bladder cancer.
In recent years there has been increasing use of molecular diagnostic tests to detect specific proteins or nucleic acids in urine to diagnose diseases such as UTIs, prostatitis, or bladder cancer. Cxbladder, for example, measures the urine concentration of messenger RNA expressed by five biomarker genes to determine the presence or absence of bladder cancer.
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Secreted Components Of Prostatic Fluid
The earliest demonstration that prostate fluids could be detected in urine specimens was reported in a 1942 publication by Scott & Huggins that demonstrated the prostatic origin of urinary acid phosphatase . These observations were validated in subsequent studies by others , providing a foundation for future investigations into biochemical analysis of urine as a way to measure biomarkers derived from prostate secretions.
Lymph Node Biopsy As A Separate Procedure
A lymph node biopsy is rarely done as a separate procedure. Its sometimes used when a radical prostatectomy isnt planned , but when its still important to know if the lymph nodes contain cancer.
Most often, this is done as a needle biopsy. To do this, the doctor uses an image to guide a long, hollow needle through the skin in the lower abdomen and into an enlarged node. The skin is numbed with local anesthesia before the needle is inserted to take a small tissue sample. The sample is then sent to the lab and looked at for cancer cells.
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The Problem With Surveillance
When a man is put into the active surveillance category, it can require invasive follow up.
Active surveillance can involve taking a PSA blood test every three months and then having an MRI or biopsy every two years.
The status is also a constant reminder that the person has cancer but his future is uncertain.
About 50 percent of men who partake in active surveillance wind up treating the cancer, even if it doesnt require treatment, researchers noted.
We currently lack the ability to tell which men diagnosed with prostate cancer will need radical treatment and which men will not, Shea Connell, PhD, a researcher and associate tutor at Norwich Medical School and the studys lead author, said in a statement.
Its clear that there is a considerable need for additional, more accurate tests, Connell said.
Identification Of A 24
The National Comprehensive Cancer Network guidelines classify PCa into five risk groups and recommend that most patients in the very high, high, and unfavorable intermediate risk groups receive treatment, while most patients in the very low, low, and favorable intermediate risk groups are placed on active surveillance. Therefore, the very high, high, and unfavorable intermediate risk groups can be classified as clinically significant PCa, and the very low, low, and favorable intermediate risk groups are classified as clinically insignificant PCa. This classification is clinically meaningful and can guide treatment decisions. We used this classification as the standard for the development of a molecular classifier.
In a previous study, we screened PCa-specific biomarker candidates and identified a 25-Gene Panel capable of distinguishing PCa from benign prostate as well as distinguishing clinically significant and insignificant cancer . Using a similar strategy, we screened various combinations of the biomarker candidates to develop a more accurate gene classifier for identifying clinically significant and insignificant PCa, especially in the low/intermediate-grade/ISUP Grade Group 13 cancer patients. We found a 24-Gene Classifier with an algorithm had the highest diagnostic accuracy, including CCND1, HIF1A, FGFR1, BIRC5, AMACR, CRISP3, FN1, HPN, MYO6, PSCA, PMP22, GOLM1, LMTK2, EZH2, GSTP1, PCA3, VEGFA, CST3, PTEN, PIP5K1A, CDK1, TMPRSS2, ANXA3, and CCNA1.
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Could A Home Urine Test Revolutionise Prostate Cancer Diagnosis Were Funding Research To Find Out
A prostate cancer urine test which has the potential to spot men with aggressive prostate cancer hit the headlines today. In partnership with Movember, were funding the next stage of research to test this in a larger group of men.
A prostate cancer urine test which has the potential to spot men with aggressive prostate cancer hit the headlines today. Now, Prostate Cancer UK and Movember are funding the next stage of research to test this in a larger group of men.
The research, led by Dr Jeremy Clark and Professor Colin Cooper at the University of East Anglia and the Norfolk and Norwich University Hospital, showed a home-based urine test has the potential to spot prostate cancer that requires treatment.
The PUR test looks at biomarkers for prostate cancer that are secreted into the urine from the cancer. This information can be used to help predict whether prostate cancer is aggressive and needs treatment, or can be monitored without treatment under active surveillance.
In the study, 14 men gave a urine sample both in the clinic after a digital rectal examination, and at home from their first urination of the day. The researchers found results from the at-home test were better at predicting which men had prostate cancer that needed treatment. In the future, an at-home urine test for monitoring prostate cancer could save men the stress, time and inconvenience of having to attend a clinic.
Adding Biomarkers Reducing Unnecessary Biopsies
The study from Dr. Sanda and his colleagues was conducted through NCIs Early Detection Research Network . It involved two groups of men: a developmental cohort, which was used to assess the initial performance of the biomarkers, and a validation cohort, which was used to see if the findings would hold in an independent group of men, explained study co-author Sudhir Srivastava, Ph.D., chief of the Cancer Biomarkers Research Group in NCIs Division of Cancer Prevention.
The 516 men in the studys developmental cohort had not previously been diagnosed with prostate cancer and were being referred for a first-ever prostate biopsy following an abnormal PSA test or DRE. Urine samples from the men collected prior to their biopsy were tested for elevated levels of the two RNA biomarkers.
The PCA3 gene is expressed at high levels in prostate cancers, and a urine test for PCA3 RNA is commonly used in clinical practice to monitor for potential disease in men who have a negative biopsy following an abnormal PSA test or DRE, Dr. Sanda explained.
There is also a urine test for T2:ERG, which is the result of a fusion, or translocation, of parts of two different genes, TMPRSS2 and ERG. This translocation is found in approximately half of advanced prostate cancers. Currently, the T2:ERG test is only available at a few academic cancer centers, Dr. Srivastava said.
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What Is The Markup Of Cancer
As defined by the American Cancer Society, tumor markers also known as tumor markers are produced by cancer cells or can also be produced by other cells in the body. These are manufactured in response to cancer or some other benign illness.
Cancer markers are still being produced for the average person, but at very low concentrations in normal tissues.
In the case of real cancer, tumor marker markers are produced by the cells, but the number will be many times higher than normal. Thanks to that, through the blood test it is possible to distinguish benign and malignant tumors.
Cancer markers can be detected through tests from a patient’s blood, urine, stool, or body fluids. Some tumor markers are specific to only one type of cancer. However, in other types of cancer, some tumor markers tend to increase quite high.
There are some cases where, although the amount of tumor markers increases, it is not cancer. This test result is called a false positive for some typical diseases such as pneumonia, hepatitis, benign breast disease
In order to diagnose cancer, it is necessary to combine cancer marker tests, diagnostic examinations with other specialized tests to have accurate results.
Therefore, when the results of different types of tumor marker tests are available, the patient should consult a doctor to understand the meaning of the indicators most accurately. Avoid the confusion that when your index increases, you think you have cancer, not because of other diseases.
Urine Processing And Quantification Of Gene Expression
For the retrospective study, 1015 mL urine samples were collected without digital rectal examination and the urine pellet was flash-frozen and stored at 80°C. For the prospective study, 1545mL urine without DRE was collected in the presence of 5mL DNA/RNA preservative AssayAssure or U-Preserve , stored at 4°C, and processed within 7 days. The urine pellet obtained after centrifugation at 1000×g for 10min was washed with phosphate-buffered saline followed by a second centrifugation at 1000×g for 10min. The cell pellet was processed for RNA purification or immediately frozen on dry ice and stored at 80°C. A detailed procedure of gene expression quantification is listed in Additional file : Methods.
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Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
Transmembrane Protease Serine : Erg Gene Fusion Via Mi
The gene fusion of TMPRSS2 and ERG creates a overexpression of the ERG oncogene driven by androgens.This TMPRSS2:ERG gene fusion occurs frequently in PCa carcinogenesis.The MiPS adds TMPRSS2:ERG mRNAto PCA3 and serum PSA to create a risk score.Its NPV for ruling out any PCa is 90% but its NPV in ruling out clinically significant PCa is unknown,although it is likely higher than 90%.Tomlins et al.showed that MiPS with the PCPT risk calculator had superior predictive accuracy compared to the PCPT risk calculator alone,demonstrating an AUC of 0.779 vs.0.707for detecting clinically significant PCa.They found that a MiPS threshold of< 15%would have avoided 36%of biopsies while missing 19 clinically significant PCa.On DCA,there was a clear net benefit of MiPS relative PCPTRC for detection of clinically significant PCa.
In Europe,Leyten et al.,in a study with 443 men undergoing biopsy for PSA> 3 ng/mL,found that adding the MiPS score to the ERSPC risk calculator increased the predictive accuracy for any PCa.They did not calculate AUC for MiPS predicting clinically significant PCa but did show that TMPRSS2-ERG was a significant predictor for Gleason score,although PCA3 was not.The investigators also showed that combining PCA< 25 and TMPRSS2:ERG< 10 would have avoided 35% of biopsies while missing 11 cases of clinically significant PCa.Both of these studies suggested that MiPS has utility in reducing biopsies without missing many cases of clinically significant PCa.
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