Testing for prostate cancer is vitally important, especially as men grow older. But for a lot of guys, the digital rectal examination – where a doctor or nurse feels your prostrate through your rectum to check for abnormalities – can be invasive and off-putting.
Prostate cancer is the most common type of cancer among men in the UK – around one in eight men will get it in their lifetime. So avoiding the test can put lives at risk.
But now a simple urine test is in development that uses urine samples collected at home to detect the cancer and determine whether it’s aggressive or not.
The test also predicts whether patients will require treatment up to five years earlier than standard clinical methods.
A study by researchers from the Norfolk and Norwich University Hospital and University of East Anglia shows how the ‘PUR’ (Prostate Urine Risk) test could be performed on samples collected at home, so men don’t have to visit their GP to provide a urine sample – or have to undergo an uncomfortable examination.
“Being able to simply provide a urine sample at home and post a sample off for analysis could really revolutionise diagnosis,” said lead researcher Dr Jeremy Clark, from UEA’s Norwich Medical School.
“It means that men would not have to undergo a digital rectal examination, so it would be much less stressful and should result in a lot more patients being tested.”
How does the PUR test work?
The test looks at gene expression in urine samples and provides information about whether a cancer is aggressive or ‘low risk’.
Prostate cancer tends to develop slowly and the majority of cancers will not require treatment in a man’s lifetime, said Dr Clark.
However doctors struggle to predict which tumours will become aggressive, making it hard to decide on treatment for many men.
The most commonly used tests for prostate cancer include blood tests, a physical examination known as a digital rectal examination (DRE), an MRI scan or a biopsy.
The test is an important step forward, say researchers, because the first urination of the day provides biomarker levels from the prostate that are much higher and more consistent.
So if men can do the test from the comfort of their homes first thing in the morning, the results are likely to be more accurate.
To test how it works, the research team provided 14 participants with a PUR test and instructions. They compared the results of their home urine samples, taken first thing in the morning, with samples collected after the rectal examination.
“We found that the urine samples taken at home showed the biomarkers for prostate cancer much more clearly than after a rectal examination,” said Dr Clark.
Perhaps unsurprisingly, feedback from the participants showed that the at-home test was preferable to the rectal examination, too.
If the test was to be rolled out, men would only need to visit the clinic for a positive urine result, said researchers. At the moment, men are recalled to the clinic every six to 12 months for “painful and expensive biopsies”.
Dr Clark said men who presented with a negative test would only need to be retested every two to three years, “relieving stress to the patient and reducing hospital workload”.
Robert Mills, consultant surgeon in urology at the Norfolk and Norwich University Hospital, branded the test a “very exciting development”.
“This test gives us the possibility of differentiating those who do from those who do not have prostate cancer so avoiding putting a lot of men through unnecessary investigations,” he said.
It is hoped the findings could also help pioneer the development of home-collection tests for bladder or kidney cancer.
Simon Grieveson, head of research funding at Prostate Cancer UK, said better testing is “urgently needed”.
“This new test is early in its development, but has the potential to offer a simple, non-invasive way of predicting aggressive prostate cancer without the need for men to attend a clinic,” he said
As the at-home urine test has only been trialled in a small number of men, Prostate Cancer UK and Movember have given funding to the team at the University of East Anglia to test this in a larger group of men.