Urine test improves prediction of High-grade Prostate Cancer

An experimental urine test that detects genetic changes associated with prostate cancer identified 92 percent of men with elevated PSA (prostate-specific antigen) levels who had high-grade cancers, according to a study published today in JAMA Oncology online.
"The test has the potential to be a significant improvement over PSA alone in distinguishing between low- and high-grade prostate cancer, especially in the PSA gray zone patient. It could reduce hundreds of thousands of invasive biopsies each year. Given the pain and risks associated with performing a prostate biopsy, that's not a trivial thing," said first author James McKiernan, MD, the John K. Lattimer Professor and chair of urology at Columbia University Medical Center (CUMC) and urologist-in-chief at NewYork-Presbyterian/Columbia. In addition, the test is the only urine-based assay that does not require a digital rectal exam prior to collection and is easily integrated in the clinic environment.
Although the PSA blood test is commonly used to screen for prostate cancer, its value has come under question. An elevated PSA level, above 4 ng/mL, only indicates that a patient may have cancer and does not reliably distinguish between low-grade cancer, which can be monitored without active treatment, and high-grade disease, which requires aggressive treatment with surgery or radiation therapy.  PSA tests yield a high number of false positive results, only 25 percent of men with an elevated PSA level have prostate cance, the US Preventive Services Task Force recommends against PSA-based screening.