A urine test for detection of high-grade prostate cancer

Prostate cancer is the most diagnosed cancer in Australia, and accounts for more than one in four cancer diagnoses in men. Although survival rates for low-grade cancers are high, metastatic (grade 4) prostate cancer is associated with a five-year mortality rate of almost two out of three.

Prostate-specific antigen (PSA) screening aids in the detection of prostate cancer but its inability to discriminate between low- and high-grade cancers results in overdiagnosis, and unnecessary and potentially harmful investigative biopsies, without clear benefit for survival.

The advent of multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has improved the detection and management of prostate cancer but there are practical and economic challenges to widespread adoption.

The recent description of a urine test for identifying high-grade cancer, offers the possibility of avoiding harms from unnecessary biopsy and the expense of imaging.

Beginning with the identification of genes associated with high-grade prostate cancer from RNA screening data, researchers narrowed in on 18 genes for which mRNA transcripts detected in the urine are quantitatively different between men with and without high-grade prostate cancer (confirmed by biopsy). The resulting 18-gene urine test has “higher diagnostic accuracy for high-grade PCa beyond currently available testing options. Clinically, use of this test would have safely avoided unnecessary additional testing with imaging or biopsy in 35% to 51% of patients while maintaining high sensitivity for high-grade cancers that stand to benefit from early detection.”

The urine test has been available in the United States since last year (a number of the study’s authors have financial interests in the company that offers the test, Lynx Dx) but it is not available in Australia.

Tim Moss

Biomedical Research Scientist

Associate Professor Tim Moss has PhD in physiology and more than 20 years’ experience as a biomedical research scientist. Tim stepped away from his successful academic career at the end of 2019, to apply his skills in turning complicated scientific and medical knowledge into information that all people can use to improve their health and wellbeing. Tim has written for crikey.com and Scientific American’s Observations blog, which is far more interesting than his authorship of over 150 academic publications. He has studied science communication at the Alan Alda Centre for Communicating Science in New York, and at the Department of Biological Engineering Communication Lab at MIT in Boston.