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At-home saliva test could help diagnose prostate cancer sooner

Tim Gunn
by Tim Gunn | News

1 June 2024

12 comments 12 comments

Sample bottles in a lab


A new saliva test for identifying men at high risk of prostate cancer could help find more cases of the disease earlier, when doctors have a better chance of treating it successfully.

The researchers behind the BARCODE 1 study, which we helped fund, say their test could help “turn the tide” on prostate cancer.

Although it is the second biggest cancer killer of men in the UK, taking around 12,000 lives a year, there is no national screening programme for prostate cancer. This is because the only current option, the prostate-specific antigen (PSA) blood test, is too inaccurate.

Instead of measuring the amount of PSA in blood, the new spit test sorts people into groups by looking through the DNA in their saliva samples for a range of small genetic changes linked to prostate cancer. The results of the trial suggest that this approach works better. The men the new test puts in its highest risk group are more likely to have prostate cancer than men with raised PSA levels.

The new test also falsely identified prostate cancer fewer times than the PSA test does, and picked up a higher proportion of aggressive cancers.

“With this test, it could be possible to turn the tide on prostate cancer,” said Ros Eeles, a professor at the Institute of Cancer Research and a consultant at the Royal Marsden NHS Foundation Trust, which jointly led the research. ”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.”

Eeles is presenting the results of BARCODE 1 at the annual American Society of Clinical Oncology meeting in Chicago. She ties her work to a long legacy of research into the genetic markers of prostate cancer.

“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.”

From PSA testing to polygenic risk scoring

In the study, spit samples were used to calculate prostate cancer polygenic risk scores (PRSs) for more than 6,000 European men. All participants were recruited through their GP surgeries when they were between 55 and 69 – an age at which risk of prostate cancer is increased.

Their PRSs were based on 130 genetic variations – many hereditary – shown to be linked with prostate cancer through studies into the DNA of hundreds of thousands of men.

For BARCODE 1, the men with the highest 10% of risk scores were invited to further screening. Following an MRI and a prostate biopsy, 187 of them (40% of the total) were diagnosed with prostate cancer. That’s a significant jump from the 25% of men identified by PSA tests who actually have prostate cancer. Moreover, 147 (78%) of the men diagnosed thanks to the new saliva test had a ‘normal’ PSA level, which would usually indicate that no further screening is required.

The researchers also took a closer look at how the prostate cancers picked up by their new test behaved (which can be assessed by looking at how abnormal they appear, measured by grade). PSA testing picks up many people who have cancers that grow too slowly to cause any significant health impacts, meaning that men may undergo unnecessary MRI scans, invasive biopsies, and treatments. Importantly, then, the new spit test identified a higher proportion of aggressive cancers – which are fast growing and likely to spread – than the PSA test. Of the 187 cancers detected in BARCODE 1, 55% were aggressive cancers, compared with 36% of those identified by a PSA test in a recent study.

The PRS test is also more accurate than an MRI scan for men who score in the highest 10% for genetic risk.

Naser Turabi, our director of evidence and implementation, put the findings into context.

“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,” he said. “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.”

Since BARCODE 1 started, an international research team has identified more genetic variants associated with prostate cancer risk in men of Asian and African ancestry. The ICR team intend to trial a saliva test for this population to ensure polygenic risk scoring can benefit all men. They are also comparing the saliva test to other potential screening options as part of the ongoing TRANSFORM trial.

This research was funded by the European Research Council, the Bob Willis Fund, Cancer Research UK, The Peacock Trust and the National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at The Royal Marsden and The Institute of Cancer Research (ICR).

    Comments

  • pinned comment
    Shaun Mullen
    3 June 2024

    How can I take a test?

  • reply
    Tim Gunn
    12 June 2024

    Hi Shaun,

    Thanks for your comment. The test isn’t available for the general public yet. Researchers are now taking a closer look at how well it works for screening in the TRANSFORM trial, funded by the government and Prostate Cancer UK.

    We’ll keep you updated on Cancer News as we find out more.

    Best wishes,

    Tim

  • Jeremy Charles Hartley
    11 June 2024

    Great research.
    I’m willing to take part as I’m waiting Biopsy results.
    Also test about links to high stomach bacteria, which I have,.
    Jeremy.

  • windrider354
    6 June 2024

    Interesting, but I don’t see mention of the percentage of prostate cancers that are not linked to any (known) DNA variants.

  • Artur Artur
    4 June 2024

    Amazing news, I pray this will be commercially available soon in Ireland, we are years behind in Ireland with genetic testing.

  • Jonathan Gardiner
    3 June 2024

    Does that mean no more biopsies? (Breathes sigh of relief) Uses in detection for other cancers?

  • reply
    Tim Gunn
    12 June 2024

    Hi Jonathan,

    Thanks for your interest in this research. The test could be a more reliable way for doctors to decide who needs a biopsy. The results so far suggest it could lead to fewer unnecessary biopsies than other methods, but it won’t replace biopsies.

    Polygenic risk scoring is showing promise for multiple types of cancer. The BCAN-RAY study is using a similar saliva test and PRS system to assess breast cancer risk.

    Best wishes,

    Tim

  • ronald james miller
    2 June 2024

    is the spit test good for men(all genetic types)and are men over 75 excluded from this test

  • reply
    Tim Gunn
    12 June 2024

    Hi Ronald,

    Thanks for your comment. These are important questions! This test is based on what we know about genetic changes linked to prostate cancer risk in European men. BARCODE 1 has shown that the idea behind the test is sound, but we now need to make sure it works for everyone, which is why the research team are working on a test that is sensitive to the different genetic risk factors in men of African and Asian ancestry.

    So far, the test has been trialled in 55 to 69-year-olds. The TRANSFORM trial is looking at whether it can be used in a screening programme for a particular age group. Any decisions about that age group will have to balance the benefits of using the test for screening with its risks, which can include false positives (when a test incorrectly indicates that someone might have cancer), false negatives (when the test incorrectly indicates someone doesn’t have cancer) and overdiagnosis (when a test finds a cancer that is growing too slowly to impact someone’s health).

    We’ll keep you updated as the research continues.

    Best wishes,

    Tim

  • thomas cass
    2 June 2024

    fantastic reseach

  • Ian Holmes
    2 June 2024

    Excellent Idea as I think many men are embarrassed I feel it would stop a lot of worry

  • Kevin Baxter
    2 June 2024

    This hopefully a game changer and fully on board. Unfortunately men are simply not being heard or seen by there GP , just simply not good enough four week wait, zero to do with covid, many many people young old falling through the inadequacy’s from all cancers.

  • Peter Salter
    2 June 2024

    I would like to thank you so very much for this amazing research you are carrying out. I personally have had prostate cancer but I was treated successfully if this can save more men from dying from this horrible disease it is a truly life changing moment.

  • Young Gerald
    1 June 2024

    If test preliminary test need to be rolled out to a larger test group, I’d be happy to take part.
    To many men die unnecessarily due to this cancer so this is a great step forward.

  • Nick Pedley
    1 June 2024

    The sooner we adopt this method of screening in the UK then the better for all men, regardless of age or ethnicity. I expect the UK won’t be adopting this screening method for at least 5 years because of all the “usual” red tape plus demands for lengthy UK based clinical trial to validate it’s efficacy and worth to the NHS.

Tell us what you think

Leave a Reply

Your email address will not be published. Required fields are marked *

Read our comment policy.

    Comments

  • pinned comment
    Shaun Mullen
    3 June 2024

    How can I take a test?

  • reply
    Tim Gunn
    12 June 2024

    Hi Shaun,

    Thanks for your comment. The test isn’t available for the general public yet. Researchers are now taking a closer look at how well it works for screening in the TRANSFORM trial, funded by the government and Prostate Cancer UK.

    We’ll keep you updated on Cancer News as we find out more.

    Best wishes,

    Tim

  • Jeremy Charles Hartley
    11 June 2024

    Great research.
    I’m willing to take part as I’m waiting Biopsy results.
    Also test about links to high stomach bacteria, which I have,.
    Jeremy.

  • windrider354
    6 June 2024

    Interesting, but I don’t see mention of the percentage of prostate cancers that are not linked to any (known) DNA variants.

  • Artur Artur
    4 June 2024

    Amazing news, I pray this will be commercially available soon in Ireland, we are years behind in Ireland with genetic testing.

  • Jonathan Gardiner
    3 June 2024

    Does that mean no more biopsies? (Breathes sigh of relief) Uses in detection for other cancers?

  • reply
    Tim Gunn
    12 June 2024

    Hi Jonathan,

    Thanks for your interest in this research. The test could be a more reliable way for doctors to decide who needs a biopsy. The results so far suggest it could lead to fewer unnecessary biopsies than other methods, but it won’t replace biopsies.

    Polygenic risk scoring is showing promise for multiple types of cancer. The BCAN-RAY study is using a similar saliva test and PRS system to assess breast cancer risk.

    Best wishes,

    Tim

  • ronald james miller
    2 June 2024

    is the spit test good for men(all genetic types)and are men over 75 excluded from this test

  • reply
    Tim Gunn
    12 June 2024

    Hi Ronald,

    Thanks for your comment. These are important questions! This test is based on what we know about genetic changes linked to prostate cancer risk in European men. BARCODE 1 has shown that the idea behind the test is sound, but we now need to make sure it works for everyone, which is why the research team are working on a test that is sensitive to the different genetic risk factors in men of African and Asian ancestry.

    So far, the test has been trialled in 55 to 69-year-olds. The TRANSFORM trial is looking at whether it can be used in a screening programme for a particular age group. Any decisions about that age group will have to balance the benefits of using the test for screening with its risks, which can include false positives (when a test incorrectly indicates that someone might have cancer), false negatives (when the test incorrectly indicates someone doesn’t have cancer) and overdiagnosis (when a test finds a cancer that is growing too slowly to impact someone’s health).

    We’ll keep you updated as the research continues.

    Best wishes,

    Tim

  • thomas cass
    2 June 2024

    fantastic reseach

  • Ian Holmes
    2 June 2024

    Excellent Idea as I think many men are embarrassed I feel it would stop a lot of worry

  • Kevin Baxter
    2 June 2024

    This hopefully a game changer and fully on board. Unfortunately men are simply not being heard or seen by there GP , just simply not good enough four week wait, zero to do with covid, many many people young old falling through the inadequacy’s from all cancers.

  • Peter Salter
    2 June 2024

    I would like to thank you so very much for this amazing research you are carrying out. I personally have had prostate cancer but I was treated successfully if this can save more men from dying from this horrible disease it is a truly life changing moment.

  • Young Gerald
    1 June 2024

    If test preliminary test need to be rolled out to a larger test group, I’d be happy to take part.
    To many men die unnecessarily due to this cancer so this is a great step forward.

  • Nick Pedley
    1 June 2024

    The sooner we adopt this method of screening in the UK then the better for all men, regardless of age or ethnicity. I expect the UK won’t be adopting this screening method for at least 5 years because of all the “usual” red tape plus demands for lengthy UK based clinical trial to validate it’s efficacy and worth to the NHS.

Tell us what you think

Leave a Reply

Your email address will not be published. Required fields are marked *

Read our comment policy.