Recent studies have shown, however, that if more than 8 biopsy cores are taken the risk may not be significantly higher than the general elderly population (approximately 18%). Nevertheless, perhaps because of delay-of-diagnosis concerns, the general practice pattern continues to be to repeat the patient's biopsy at least once if HGPIN is identified.

Some investigators have suggested that the HGPIN literature is conflicting because it is not uniformly apparent on prostate biopsies due to its multifocality. Identifying a urine marker for HGPIN may reliably identify men at a greater risk for developing prostate cancer.

In the February 1st issue of Clinical Cancer Research, Hu and colleagues from the Department of Pathology at Drexel University report on an experimental study designed to develop a urine-based assay for identifying HGPIN. The test is based on the identification of ABCA5, a protein overexpressed in the urine and tissue of patients with HGPIN. Using electrophoretic mobility shift assays, immunohistochemistry, and ELISA, the authors measured expression of the ABCA5 protein in the tissue and urine of men with and without HGPIN. Both DNA and protein data showed that ABCA5 was overexpressed in the tissue and urine of all patients with HGPIN but not expressed in patients with prostate cancer or BPH. Using banked urine from 107 men with known HGPIN and 79 men without HGPIN in a blinded fashion, the presence of more than 25 ng/mL of ABCA5 protein in the urine predicted the presence of HGPIN in 98% of cases (sensitivity) with a specificity of 86%.

These data show that a urine test may reliably predict the presence of prostatic intraepithelial neoplasia. While the clinical application of this technology is yet undetermined, this study is certainly a step forward towards the goal of identifying a reliable urine-based assay for prostate cancer screening which outperforms serum PSA.

Youji Hu, Min Wang, Karen Veverka, Fernando U. Garcia, and Mark E. Stearns

Clin Cancer Res. 2007 Feb 1; 13(3):929-38

Written by Ricardo Sånchez-Ortiz, MD, a Contributing Editor with UroToday.

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