Fox Chase Cancer Center Research Shows Kidney Cancer Can Be Diagnosed in Urine
PHILADELPHIA -- Fox Chase Cancer Center researchers have demonstrated the ability to identify kidney cancer, including localized (stage I) cancer, in the urine of affected patients. What's more, urine tests were repeated following the removal of the cancerous kidney and none of the tests showed DNA evidence of disease. These research findings were presented at the American Urological Association Annual Meeting May 8-13, 2004 in San Francisco.
As with other cancers, an early diagnosis of kidney cancer can result in curative treatment whereas the prognosis for advanced kidney cancer is poor. The challenge in diagnosing cancer early is developing an inexpensive, noninvasive, accurate and simple screening test. A urine test meets these standards.
"We used a common laboratory procedure to test the urine of 50 patients with kidney cancer," explained Fox Chase molecular biologist Paul Cairns, Ph.D. "Forty-four of the 50 tests showed gene changes in the urine that were identical to the gene changes found in the tumor tissue taken at the time of surgery."
When the same test was conducted on the controls - urine from people without cancer - none showed the relevant gene alterations that were found in the urine from people with cancer.
"The test appears to be remarkably accurate with no false-positives in this study," said Robert G. Uzzo, MD, a urologic surgeon at Fox Chase and lead author of the abstract. "In addition, one of the most impressive outcomes of this research is that the test also identified 27 of the 30 patients with stage I disease."
The researchers then tested the urine of 17 patients after they had surgery to remove the cancerous kidney. Mutated genes present in the urine prior to the kidney removal were not present in the urine after the kidney was removed.
"This step in our research further supports the accuracy of this potential screening test but also demonstrates the possibility of using urine to monitor the patient after treatment," Uzzo added.
The researchers used a molecular DNA-based test called methylation-specific PCR (polymerase chain reaction) to detect gene alterations that initiate and fuel the onset of cancer. The test searched for six cancer specific tumor-suppressor genes that were altered - causing them to falter in their critical role of preventing errant cell growth. These six genes are usually identified only after a pathologist's review of tumor tissue.
"In addition to early detection, differential diagnosis and surveillance, this testing could potentially be extended in the future to simultaneously provide molecular staging and prognostic information," Uzzo concluded.
Currently, kidney cancer is diagnosed after radiographic imaging of the kidney, which may include an ultrasound, CT scan and/or MRI. Biopsy of a kidney mass is often difficult to interpret or may give a false negative result and therefore currently confirmation of radiographic results is primarily after surgical excision. There is no protein marker test for kidney cancer as there is for prostate cancer with the PSA test.
This research was supported in part by a grant from the Flight Attendants Medical Research Institute (FAMRI) and the National Cancer Institute's Early Detection Research Network.
Fox Chase Cancer Center, part of Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase also was among the first institutions to receive the National Cancer Institute’s prestigious comprehensive cancer center designation in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are routinely recognized in national rankings, and the Center’s nursing program has achieved Magnet status for excellence three consecutive times. Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research and oversees programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX-CHASE (1-888-369-2427).