Further reading and news reports

Urinary engrailed-2 (EN2) levels predict tumour volume in men undergoing radical prostatectomy for prostate cancer.
Pandha H, Sorensen KD, Orntoft TF, Langley S, Hoyer S, Borre M, Morgan R. BJU Int. 2012 Sep;110(6 Pt B):E287-92

Engrailed-2 (EN2): A Tumor Specific Urinary Biomarker for the Early Diagnosis of Prostate Cancer. 
Morgan R, Boxall A, Bhatt A, Bailey M, Hindley R, Langley S, Whitaker HC, Neal DE, Ismail M, Whitaker H, Annels N, Michael A, Pandha H. Clin Cancer Res. 2011 Mar 1;17(5):1090-8




Biomarkers - Engrailed-2 (EN2) urine test for the diagnosis of prostate cancer


PSA is an important and useful test for prostate cancer. However, its use is limited by the fact that PSA levels also increase in non-cancerous conditions of the prostate. We have developed a more reliable way of detecting prostate and bladder cancers, by testing a small urine sample. We focused on the EN2 protein produced by these types of cancers, and which is secreted into urine. Importantly, the amount of EN2 in urine can also provide information about how large a tumour is.

We have published our work in the journals Clinical Cancer Research and British Journal of urology, and we have received wide spread publicity in the media.  Clinical trials in both Europe and the United States have found that the EN2 biomarker test is twice as effective as the 30-year-old PSA blood test currently used to detect prostate cancer. Work is on going to improve the accuracy of the test and address its potential in diagnosis and surveillance.  It is hoped that a test could be made available in GP surgeries around the world. Hardev Pandha, Professor of Medical Oncology: " This new test could lead to faster detection that could save hundreds of lives, and also offers the potential for huge cost savings. "Unlike in previous tests that require invasive procedures to produce a trigger, our studies show that the EN2 test immediately shows up and that levels of the protein correlate strongly with how far the disease has spread. This may then help a doctor assess whether the disease may be safely and actively monitored, or whether it has spread more widely and requires treatment."

The samples collected were subsequently used in many research projects that looked into the early diagnosis and prognosis of prostate cancer. One of the main collaborations is the PRACTICAL consortium. PRACTICAL is a collaborative international group of researchers interested in inherited risk of prostate cancer. Many groups are conducting studies with the aim of identifying genes that may be related to the risk of prostate cancer. The aim of the group is to combine data from many studies, to provide a reliable assessment of the risks associated with these genes. Co-ordination of PRACTICAL is funded by Cancer Research UK. This collaboration led to a number of new discoveries and high impact publications. 

Examples include new discovery of genetic abnormalities called SNIP that predispose men to get prostate cancer. This research included samples from 87, 040 men and has been published in Nature Genetics in 2015. Another example is a large study looking at the link of high body mass index and tall stature with the risk of prostate cancer. This analysis was conducted looking at the samples and information gathered from close to 50000 men and has also been published. We also collaborate with scientists in Canada who look into new information that can be gathered from small fragments of nucleic acids in the cell that  can help in defining whose cancer is more aggressive. These nucleic acid fragments ae called SNORA55 and the research has now been published in Molecular Oncology Journal. The collaborations with scientists all over the world continue and new significant findings are reported in scientific journals. 

Thanks to Prostate Project we are one step closer to understanding prostate cancer. 

The SUN Study

​​​Dr Agnieszka Michael

Copyright ©​  The Prostate ProjectAll Rights Reserved. Tel 07724465883 info@prostate-project.org.uk  Charity No. 1078523

​​​giving men a better chance of beating prostate cancer 

Work on the EN2 urine test to diagnose prostate cancer continues at the University of Surrey, Section of Oncology with a well established collaboration with Randox Ltd, Belfast.

We have ethical approval to commence a large clinical study (called PROCURE) which, if successful, we hope will allow us to move EN2 into the clinic for routine clinical use. However, at the moment, EN2 is a research concept and not a test that can be ordered or purchased. We hope to complete the clinical trial in winter 2018.  Details of the clinical trial can be found below and on the University website. The study is led by Mr Simon Bott, Consultant Urologist at Frimley Park Hospital, Camberley, Surrey.

The study is aimed at recruiting patients from the Surrey area. If you are not from this area, any enquiries to participate in the study should go through your general practitioner. Please do not contact the research team or Mr Bott directly.

Only men with a PSA between 4 and 20 ng/ml who do NOT have a prior history of prostate cancer will be eligible. Please note, neither University of Surrey or Randox Ltd are able to perform the EN2 test outside this clinical trial.


Utility of urinary engrailed-2 for the diagnosis of clinically significant prostate cancer

Investigators: Mr Simon Bott, Consultant Urologist, Frimley Park HospitalProf Hardev Pandha, University of Surrey

The purpose of this project is to assess the clinical utility of the urinary biomarker engrailed-2 (EN2) in diagnosing clinically significant prostate cancer.  This study is anticipated to complete Winter 2018. The study will include patients from the Royal Surrey, Basingstoke, Frimley Park and Wexham  hospitals.

500 men with PSA between 4 and 20 ng/ml will be included having been referred by the GP. A blood and urine sample will be taken in the clinic and stored.

These men will then proceed though the normal patient pathway and have clinical examination, magnetic resonance scan of the pelvis and prostate biopsies as appropriate.  At the end of the study, the stored urine will be tested for the presence of EN2 protein. The researchers will ask:

Did the presence of EN2 correlate with the diagnosis of prostate cancer (as determined by the prostate biopsies)
In the prostate cancer patients, did the amount of EN2 correlate with the amount of disease present (in other words did larger (clinically significant) cancers make a lot of EN2, and smaller  (insignificant) cancers little EN2?)

The results of the study should be available in the autumn of 2016. We will keep everyone informed as the study proceeds through the Prostate Project Charity website.

A simple 'dipstick' urine test

for prostate cancer.

The SUN study is an example of a successful project delivered with the support of Prostate Project charity.  The SUN study is a biobank of serum and DNA samples from patients with prostate cancer that started approximately  7 years ago.  The primary purpose of the SUN study was to collect blood samples from men with a diagnosis of prostate cancer and compare these with samples from an age-related group of healthy men to detect new biomarkers and aid in the early detection and monitoring of prostate cancer. Over the next 2-3 years we consented approximately 600 men, of those 314 men had a diagnosis of prostate cancer and 278 were healthy volunteers. The study has an NHS ethics approval, protocol and consent form and although the active collection has now stopped the biobank contains serum samples, DNA samples and some urine samples.

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