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Study raises hope of urine prostate cancer te -

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Study raises hope of urine prostate cancer test

The World Today - Thursday, 12 February , 2009 12:51:00

Reporter: Sara Everingham

BRENDAN TREMBATH: Scientists in the United States say they're a a step closer to developing a urine
test to distinguish between benign and aggressive forms of prostate cancer.

At the moment it's hard to tell them apart and it means some patients have unnecessary treatment.

Experts in Australia say the US study is promising but more tests will be needed.

Sara Everingham reports.

SARA EVERINGHAM: Each year in Australia there are around 18,000 new diagnoses of prostate cancer.
The difficulty for doctors is knowing how serious it is.

Dr Phillip Katelaris is a urologist and a director of the Prostate Cancer Foundation of Australia.

PHILLIP KATELARIS: We know of course that prostate cancer activity spreads, it covers a very wide
range of clinical activity from virtually non-active indolent prostate cancer, right through to
highly malignant, aggressive prostate cancer.

And what we don't have as yet is an accurate way of knowing which prostate cancers will behave
aggressively and therefore which cancers need aggressive medical intervention.

SARA EVERINGHAM: The dilemma can sometimes lead to over-treatment - whether it's screening,
radiation therapy or surgery.

Associate professor Philip Stricker is the director of the St Vincent's Prostate Cancer Centre.

PHILLIP STRICKER: We already try and not over-treat the older men and the people with very low
aggressive cancers but we probably still over-treat it so it would be nice to have a market to
decrease that yet further.

SARA EVERINGHAM: Researchers in the United States think they're close to finding it. In a new study
published in the journal Nature they say they're one step closer to developing a urine test to
differentiate aggressive from non-aggressive types of prostate cancer.

The lead researcher is professor Arul Chinnaiyan from the University of Michigan. He spoke to the
BBC.

ARUL CHINNAIYAN: There might be screening tests for the presence of prostate cancer and you would
then get a follow-up test. That test would tell you whether you would need treatment for that
prostate cancer, whether it be surgical treatment or radiation treatment. Otherwise we would just
monitor those patients.

SARA EVERINGHAM: The researchers examined more than 1000 molecules or metabolites produced by the
body in 260 tissue blood or urine samples.

One in particular, sarcosine, was often found at elevated levels in samples taken from patients
with advanced cancer. In fact they found sarcosine was a better indicator of advancing disease than
the traditional marker - prostate specific antigen - or PSA.

But experts here warn the research is in its early days.

Associate professor Phillip Stricker again.

PHILLIP STRICKER: It is certainly one of the many studies that are now reporting markers which may
turn out to differentiate aggressive from non-aggressive types of cancer. The problem with it is
the numbers are small and it hasn't been properly tested in clinical testings.

Until you test it on human beings in real situations, you are not really sure whether it's got the
strength to hold out and really be the holy grail.

SARA EVERINGHAM: He says those clinical tests could be done in two years but even then there's a
need for caution.

PHILLIP STRICKER: I think you have to go at it logically and one step at a time otherwise what will
happen is you will over-spruik these things and then suddenly you will have a test which is
inaccurate and you will be making clinical decisions based on it.

SARA EVERINGHAM: Eventually he says the search for prostate cancer markers will lead to less
invasive screening and other changes in the way patients are treated.

PHILLIP STRICKER: With some of the new less aggressive therapies, which we are trialling as well,
it may be that the less aggressive ones get less aggressive focal treatment or nothing and the more
aggressive ones get the more aggressive therapy like surgery or radiotherapy or chemotherapy.

SARA EVERINGHAM: Dr Phillip Katelaris agrees changes to treatment lie ahead.

PHILLIP KATELARIS: If we were able to use a blood sample, a urine sample, a semen sample to measure
metabolites that were highly predictive of whether a man would or would not get prostate cancer and
to predict the behaviour of that prostate cancer clinically, that would go a long way towards
solving a lot of the prostate cancer dilemma.

BRENDAN TREMBATH: Dr Phillip Katelaris, a director at the Prostate Cancer Foundation of Australia.
That report from Sara Everingham.