Prostate cancer urine test indicates disease aggression

Wednesday, 28 April, 2021

Prostate cancer urine test indicates disease aggression

An experimental new urine test for prostate cancer, dubbed ‘ExoGrail’ and developed by UK researchers, has the potential to revolutionise how patients with suspected prostate cancer are risk-assessed prior to an invasive biopsy. Described in the journal Cancers, the new test has the ability to reduce the number of unnecessary prostate cancer biopsies by 35%.

Prostate cancer is the most common cancer in men in the UK, but it usually develops slowly and the majority of cancers will not require treatment in a man’s lifetime. 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 an invasive biopsy; however, doctors struggle to predict which tumours will become aggressive, making it hard to decide on treatment for many men.

“While prostate cancer is responsible for a large proportion of all male cancer deaths, it is more commonly a disease men die with rather than from,” said Dr Dan Brewer from the University of East Anglia, lead researcher on the new study.

“Therefore, there is a desperate need for improvements in diagnosing and predicting outcomes for prostate cancer patients to minimise overdiagnosis and overtreatment whilst appropriately treating men with aggressive disease, especially if this can be done without taking an invasive biopsy.

“Invasive biopsies come at considerable economic, psychological and societal cost to patients and healthcare systems alike.”

The research team developed the ExoGrail urine test by combining two biomarker sources: measurements of a protein-marker called EN2 and the levels of gene expression of 10 genes related to prostate cancer risk. They tested it using urine samples from 207 patients who had undergone a biopsy for prostate cancer at the Norfolk and Norwich University Hospital (NNUH).

When the urine results were compared to biopsy results, the study showed that the test had successfully shown which patients had prostate cancer and which did not. ExoGrail also provided risk scores for patients and highlighted those for which an invasive biopsy would have been beneficial. The findings therefore show that using information from multiple, non-invasive biomarker sources has the potential to greatly improve how patients with suspected prostate cancer are risk-assessed prior to an invasive biopsy.

“Our new urine test not only shows whether a patient has prostate cancer, but it importantly shows how aggressive the disease is,” Dr Brewer said. “This allows patients and doctors to select the correct treatment. And it has the potential to reduce the number of unnecessary biopsies by 35%.”

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