A simple urine test, developed at the University of Surrey may greatly improve patient quality of life and has the potential to save the NHS in excess of £100 million every year.
The test, developed by Dr Richard Morgan and Prof Hardev Pandha looks for traces of the EN -2 protein in the urine, a protein which has been found to exist in bladder and prostate cancer patients. The test will help in the early detection of bladder cancer and could allow doctors to diagnose and treat patients without using invasive and costly procedures, such as cystoscopies.
The test will allow new patients to be quickly and easily diagnosed as well as allowing existing patients already undergoing treatment to be more easily monitored. The Surrey team analysed urine from a large group of bladder cancer patients and healthy ‘control’ patients from Birmingham. The research was published in the European Journal of Cancer last month.
There are 10 000 new cases of bladder cancer every year with up to 20% of people going on to die from the disease. Once a patient is diagnosed with bladder cancer it is likely the patient will go through many years of treatment – making it one of the most expensive cancers to manage. This new test will help alleviate this burden, both to the NHS and to individual patients undergoing treatment.
Professor Hardev Pandha of Medical Oncology at the University of Surrey’s Postgraduate Medical School said:
“Bladder cancer is one of the most expensive cancers to manage. During the course of treatment, patients can endure multiple invasive procedures, used to monitor the success of surgeries and drug therapy programmes. This simple test challenges the need for such routine and invasive procedures, greatly improving the experience for patients and saving the NHS a considerable amount of money”.
How was this discovery made?
EN-2 is one of a number of genes that has an important role in the development of the early embryo, and researchers at the University of Surrey are interested in the possible function of such genes in cancer. For this reason they looked to see whether EN-2 is present in bladder cancer. When they did, they found that not only is EN-2 present in bladder tumours but it is actively secreted from these tumours. This suggested that it could be present in urine, which indeed it is.
What is EN2?
EN-2 is a protein that acts as an on-off switch for genes and as such has a key role in controlling the behaviour of cells.
Why is it better than existing tests?
The current ‘gold standard’ test is a cystoscopy. This test involves an internal examination of the bladder with the patient undergoing general anaesthetic. This new urine test could remove the need, in some cases, for cystoscopies removing the burden from patients and alleviating some of the cost to the NHS.
There are a number of currently available urine tests for the diagnosis of bladder cancer but have such variable reliability for diagnosis than none is used routinely.
How accurate is it?
The simple urine test had an extremely high sensitivity for the detection of bladder cancer in the recent study, which was an improvement on all other urine tests and which approached the sensitivity of cystoscopy. The amount of EN2 in the patients urine corresponded to the aggressiveness and volume of their cancer. EN-2 has been detected in individuals with recurrent bladder cancer as well.
What trials have been carried out?
The published study is the first evaluation of EN-2 to diagnose bladder cancer. Further studies are on-going.
Will this lead to National Screening?
This is one possibility, yes. The performance of the test will be particularly helpful in the on-going mentoring and assessment of former bladder cancer patients.
Will it put a lot of additional strain on the NHS?
Bladder cancer is the sixth most common cancer in the UK and has a high recurrence rate. This means that on-going levels of patient care is high, therefore making it one of the most expensive cancers to treat. This test has the potential to save the NHS in excess of £100 million a year by monitoring patients by urine test and not cystoscopy with obvious advantages for patients.
Can my local GP do the test?
Initially, the samples will be sent away for analysis. However, the test will be easy to administer. A urine sample is all that will be required from the patient. The test itself will be carried out in a hospital laboratory.
Which (major pharmaceutical) companies are developing it?
Talks are on-going with several companies.
When will it be available?
As soon as the appropriate regulatory hurdles are cleared. 12 -18 months for widespread use, possibly sooner for specialist use.
Does it detect other types of cancers?
Research by the University of Surrey research team is on-going to answer this question.
How was the work funded?
The work was funded by the University of Surrey and the Prostate Project Charity. The published study was funded and supported by Cancer Research UK (CRUK).
University of Surrey