Urine Biomarker Helps Classify Risk Level in Prostate Cancer

Urine-derived extracellular vesicle RNA can provide diagnostic information for aggressive prostate cancer prior to biopsy as well as prognostic information for men under active surveillance for prostate cancer, according to a study published online in BJU International.

Shea P. Connell, Ph.D., from Norwich Medical School at the University of East Anglia in the United Kingdom, and colleagues developed a risk classifier using urine-derived extracellular vesicle RNA expression profiles for prostate cancer. Four prostate urine risk (PUR) signatures were generated to predict the probability of normal tissue, D'Amico low-risk, intermediate-risk, and high-risk (PUR-1, PUR-2, PUR-3, and PUR-4, respectively) prostate cancer. The model was applied to 177 men for diagnostic evaluation and, in an active surveillance (AS) cohort, to 87 men for prognostic evaluation.

The researchers observed a significant correlation for each PUR signature with its corresponding clinical category. The presence of clinically significant intermediate-risk or high-risk disease was predicted by PUR-4 status with an area under the receiver operating characteristic curve of 0.77. PUR application provided a net benefit over current clinical practice. In the AS cohort, definition by PUR status and proportion of PUR-4 were significantly associated with time to progression (interquartile range hazard ratio, 2.86). When utilized continuously, PUR-4 dichotomized patient groups with differential progression rates of 10 and 60 percent at five years after urine collection (hazard ratio, 8.23).

"Our urine test could be used to not only diagnose prostate cancer without the need for an invasive needle biopsy but to identify a patient's level of risk," one coauthor said in a statement.

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