Categorized | Prostate Inflammation

Urine Test Can Help Detect and Sort Prostate Cancer

Researchers report that an investigational urine test can detect and stratify prostate cancer in men with elevated prostate specific antigen (PSA).  According to Arul Chinnaiyan, MD, PhD, of the University of Michigan Medical School in Ann Arbor and colleagues, the test is based on the detection of a gene fusion that is specific to prostate cancer combined with another marker.  Stratifying patients by the combined marker identified groups with markedly different risks of cancer, high-grade cancer, and clinically significant cancer on biopsy.

This noninvasive test may allow some men with elevated PSA to avoid a needle biopsy.  Although many more men have elevated PSA than actually have cancer, the test could be an intermediate step before getting a biopsy.

The fusion that doctors look for in the test involves the genes transmembrane protease, serine 2 (TMPRSS2), and v-ets erythroblastosis virus E26 oncogene homolog (avian) (ERG).  This fusion appears in roughly half of all prostate cancers, but when it does appear, it is almost 100% specific for malignancy.  Through a series of experiments, the research team showed that the fusion gene was associated with indicators of clinically significant cancer at biopsy and prostatectomy.  The indicators included tumor size, high Gleason score at prostatectomy, and upgrading of Gleason grade at prostatectomy.

Because this fusion gene is not always present, the team created a model that combined it and the prostate cancer antigen 3 (PCA3) gene.

The researchers use the model to stratify 1,065 men who underwent biopsy into three groups – lowest, intermediate, and highest levels of the combined genes.

These tests, however, remain investigational.  Additionally, the researchers note that most of the men studied thus far have been Caucasian.  More studies are needed to see if the results can be generalized.

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October 2011
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