title: Prostate cancer detection on urinalysis for alpha methylacyl coenzyme a racemase protein.
abstract: OBJECTIVE
  We assessed the feasibility of a novel urinary test for prostate cancer based on the presence of alpha methylacyl coenzyme A racemase (AMACR) protein in voided urine specimens obtained after prostate biopsy.
  
  
  METHODS
  Clean catch voided urine specimens were prospectively collected from 26 consecutive men immediately after transrectal ultrasound guided prostate biopsy for suspected malignancy. The presence of AMACR was evaluated in a blinded manner by Western blot analysis and correlated with biopsy results and patient clinical information.
  
  
  RESULTS
  AMACR was detected in the urine in 18 of 26 patients (69%). AMACR was detected in all 12 patients with biopsy confirmed adenocarcinoma of the prostate (100% sensitivity, 95% CI 75 to 100), in 5 of 12 with no evidence of cancer on biopsy (58% specificity, 95% CI 29 to 78) and in 1 of 2 (50%, 95% CI 3 to 80) with atypia on biopsy. Overall AMACR detection was associated with cancer status by prostate biopsy in 21 of 26 patients (86%).
  
  
  CONCLUSIONS
  We report the feasibility of a novel, noninvasive, nonprostate specific antigen based molecular approach to detect prostate cancer in voided urine. To our knowledge this is the first report of AMACR protein detection in the urine of patients with prostate cancer. A screening test based on urinary AMACR may develop into a useful adjunct to serum prostate specific antigen and digital rectal examination for identifying men at increased risk for harboring prostate cancer despite negative biopsy. Such a test has potential application for stratifying patients into low and high risk groups for surveillance vs repeat biopsy.
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. crogers6@jhmi.edu
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: Gai
authors.initials: G
authors.lastname: Yan
authors.forename: Shan
authors.initials: S
authors.lastname: Zha
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gonzalgo
authors.forename: William B
authors.initials: WB
authors.lastname: Isaacs
authors.forename: Jun
authors.initials: J
authors.lastname: Luo
authors.forename: Angelo M
authors.initials: AM
authors.lastname: De Marzo
authors.forename: William G
authors.initials: WG
authors.lastname: Nelson
authors.forename: Christian P
authors.initials: CP
authors.lastname: Pavlovich
mesh_terms: D000214:Acyl Coenzyme A / Q000652:urine*; D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D000368:Aged; D014408:Biomarkers, Tumor / Q000652:urine*; D001706:Biopsy; D015153:Blotting, Western; D019175:DNA Methylation; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology / Q000652:urine; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000378:metabolism / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D019998:Racemases and Epimerases
chemical_list: D000214:Acyl Coenzyme A; D014408:Biomarkers, Tumor; D019998:Racemases and Epimerases