Experimental Urine Test Successfully Predicts Prostate Cancer

The prostate is only found in men and its function includes producing seminal fluid which aids in transporting sperm. Prostate cancer is one of the most common types of cancer which involve men, and it's a slow growing cancer which initially stays confined to the prostate. Prostate cancer is the second most frequently diagnosed cancer in males after lung cancer and it is the sixth leading cause of cancer deaths in men worldwide as well.

Symptoms and signs of prostate cancer

The early stages of prostate cancer may cause no signs and symptoms. When the cancer becomes more advanced, then signs and symptoms may include the following:

• There's a decreased force in the stream of urine.
• Trouble urinating.
• Blood in the semen.
• Erectile dysfunction.
• Pelvic area discomfort.
• Bone pain, especially the lower back.

Risk factor for developing prostate cancer

Certain factors increase the risk of developing prostate cancer and they include the following:

• Advancing age - the risk of developing this cancer increases with age. A study found that 80% of men above the age of 80 who had died of other causes had prostate cancer.
• Race - black men seem to be more at risk for developing prostate cancer when compared to other races. The prostate cancer in black men also tends to be more advanced or aggressive but the reason for this in unknown.
• Family history of prostate or breast cancer - if there are any first degree relatives, such as brothers or fathers, who were diagnosed with prostate cancer then the risk of getting prostate cancer increases. It also seems that if there's a family history of breast cancer, or the presence of genes which increase the risk of breast cancer (BRCA1 or 2), then this also increases the risk of prostate cancer.
• Obesity -  men diagnosed with prostate cancer who are also obese seem to be more likely to struggle with the management of advanced disease.

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Complications

Complications may arise secondary to advanced prostate cancer or even the treatment of this cancer. These may include the following issues:

• Urinary incontinence - the reason for this can be due to obstruction caused by the cancer or due to narrowing of the urethra due to certain treatments of prostate cancer such as radiation therapy or brachytherapy. This can be managed though with certain medications and the use of catheters and surgery to remove any strictures.
• Metastatic cancer - prostate cancer can spread to nearby organs such as the rectum and the bladder and can spread to other organs and bones via the bloodstream and the lymphatic system. 
• Erectile dysfunction - the cause of this issue is the same as mentioned above. Managing this can be done with certain medications and the use of vacuum devices as well as surgical implants.

Screening For Prostate Cancer

99% of cases of prostate cancer primarily develop in men over the age of 50. Therefore, diagnosing cancer in these patients may lead to unnecessary and painful biopsies being done and then over-treating the patient at the end of the day. This would then lead to exposing the patient to complications and side effects which could have been prevented if the correct protocols were followed. The first rule of medicine is to do no harm.

The way prostate cancer is diagnosed and staged is by performing biopsies of the prostate. This includes inserting a large bore cutting needle multiple times through the perineum to reach different parts of the prostate. Many small specimens are collected in order to cover as large an area of the prostate as possible. Besides being a very uncomfortable procedure, this investigation can result in side effects and complications and that is why screening correctly for prostate cancer is so important.

The American Cancer Society has made the recommendation that men should discuss screening for prostate cancer with their primary care doctors. The decision to be screened should then be made after the patient has received the necessary information regarding any risks and benefits associated with screening.

The discussion regarding prostate screening should be done at:

• Age 50 for men who have an average risk of developing prostate cancer and who are expected to survive 10 or more years.
• Age 45 for men who are high risk candidates for developing prostate cancer. This would include black men and men who have a relative (such as a son, brother or father) who were diagnosed with prostate cancer before age 65.
• Age 40 for men who are at an even higher risk (those with more than one above-mentioned relative who had prostate cancer at an early age).

A patient who isn’t expected to live over the next 10 years shouldn’t have any prostate screening done because even if they are diagnosed with prostate cancer, no further management will be initiated.

If the patient agrees and gives consent to screening then blood is drawn to check for the prostate-specific antigen (PSA) level which is a protein released by the prostate in conditions such as prostate cancer. A digital rectal exam (DRE) is also done to feel the consistency of the prostate and to see whether any nodules are felt.

Experimental urine test

The urine test is called ExoDxTM Prostate and it detects RNA from 3 genes (namely ERG, PCA3 and SPDEF) which have been linked to the development and progression of prostate cancer. The RNA of these genes is bound in exosomes which are excreted by the cancer cells into the urine.

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This analysis of the results of the test showed that it correctly spotted 92% of patients with already diagnosed high-grade cancer. The test also found high-grade cancer in 66% of patients whose biopsies showed low-grade or no cancer. In a clinical setup, use of the test would have spared 27% of patients from having unnecessary prostate biopsies done.