Simple spit test that can 'turn the tide' on prostate cancer

Male doctor and testicular cancer patient are discussing about testicular cancer test report. Testicular cancer and prostate cancer concept.
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A ground-breaking genetic test is positioned to "turn the tide on prostate cancer", potentially saving thousands of lives each year.

This straightforward spit test, conducted at home, investigates markers in patients' DNA to discern those at elevated risk of contracting the disease. Patients identified as high-risk could then undergo additional checks, enabling earlier diagnosis when treatments are most likely to succeed.

A significant study discovered this test was superior at identifying cancer than the current blood test given by GPs. Supposing further research validates this, the test might be applied to screen men exhibiting symptoms or considered high-risk due to age or ethnic background, reports the Express.

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The trial was spearheaded by Professor Ros Eeles, a specialist in oncogenetics at The Institute of Cancer Research (ICR) in London and consultant at The Royal Marsden NHS Foundation Trust. During her presentation of the findings at the American Society of Clinical Oncology's yearly conference in Chicago, she said: "With this test, it could be possible to turn the tide on prostate cancer."

"We have shown that a simple, cheap, spit test to identify men at higher risk due to their genetic makeup is an effective tool to catch the cancer early. Building on decades of research into the genetic markers of prostate cancer, our study shows that the theory does work in practice we can identify men at risk of aggressive cancers who need further tests, and spare the men who are at lower risk from unnecessary treatments."

The trial, known as BARCODE 1, enlisted over 6,100 men aged between 55 to 69 who were randomly selected from GP surgeries across Europe. They provided a sample which was checked for 130 genetic variations in DNA code that have been linked to prostate cancer, and received a risk score.

Some 558 men with the highest 10 percent of risk scores underwent further tests and 468 had a biopsy. Of those, 187 (40 percent) were diagnosed with cancer.

This suggests the spit technology was more effective than the commonly used prostate specific antigen (PSA) blood test which looks for hormones linked to the disease. Only around 25 percent of men flagged by the PSA test turn out to have cancer, making it too unreliable for use in a national screening programme.

The saliva test also identified a higher proportion of aggressive cancers, which are fast growing and likely to spread: 55 percent of cases it identified were aggressive, compared to 35 percent for the PSA test. The spit test was also more accurate than an MRI scan for those with high genetic risk: 119 men in the study had prostate cancer confirmed by a biopsy that was not detected by the MRI.

Some 62 of the 187 cancers diagnosed required treatment and the rest were put on active monitoring. The saliva test, which costs less than £200, will now be evaluated in a £42 million trial of the most promising technology.

The TRANSFORM trial, hailed as the largest prostate cancer screening study in two decades, is poised to pave the way for a national screening programme. Researchers are also exploring other methods such as the PSA test and expedited 12-minute MRI scans.

Prof Eeles said: "Our next step will be for us to test the genetic markers we have identified that are associated with a risk of prostate cancer in diverse populations, to ensure this test can benefit all men. We are currently comparing the saliva test to other potential screening options, as part of the TRANSFORM trial, to assess the most cost-effective and accurate way to screen men for prostate cancer."

Prostate cancer affects approximately 53,000 men annually and is responsible for 12,000 deaths each year, making it the leading cause of cancer death among men. Professor Kristian Helin, chief executive of the ICR, described the research as "a promising step" towards establishing a screening programme.

He said: "Cancers that are picked up early are much more likely to be curable, and with prostate cancer cases set to double by 2040, we must have a programme in place to diagnose the disease early. We know that the current PSA test can cause men to go through unnecessary treatments and, more worryingly, it's missing men who do have cancer. We urgently need an improved test to screen for the disease."

Naser Turabi, director of evidence and implementation at Cancer Research UK, which contributed to the funding of the study, added: "Right now, there's no reliable method to detect aggressive prostate cancer, but this study brings us a step closer to finding the disease sooner in those people who need treatment. It's encouraging to see that genetic testing might help to guide a more targeted approach to screening based on someone's risk of developing prostate cancer. More research is now needed to confirm if this tool can save lives from the disease so that it can be rolled out to improve diagnosis."

Dheeresh Turnbull and his brother Joel
Dheeresh Turnbull and his brother Joel -Credit:Dheeresh Turnbull

Dheeresh Turnbull will forever be thankful to the BARCODE 1 study after it saved not just one, but two lives in his family. The 71-year-old was diagnosed with prostate cancer after being randomly recruited via his GP surgery despite having no symptoms.

Dheeresh, a Brighton-based former cognitive behavioural therapist and lecturer, said: "It's incredible to think that because of this study two lives have now been saved in my family." He participated in the study three years ago and after submitting his saliva sample for analysis, he was taken aback to learn that his genetic risk score fell into the highest 10 percent.

An MRI and prostate biopsy confirmed the diagnosis and he underwent robotic surgery to remove part of his prostate.

He said: "I was completely shocked when I received my diagnosis as I had absolutely no symptoms at all, so I know I would never have been diagnosed at this stage if I hadn't joined the trial." Furthermore, when his younger brother Joel signed up, he too was discovered to have an aggressive tumour.

Dheeresh added: "Because the saliva test revealed that I had a high genetic risk of developing the disease, my younger brother, who would have been too young to join the study directly, signed up and discovered that he also had an aggressive tumour in the prostate."