Investigation Into Detection of Prostate Cancer Using Voided Urine (Prostate VPAC)

This is an observational study. No therapy is involved, and no treatment decisions are made as a part of this study. Patients will have biospecimen collected at either Urology clinics located at Jefferson Urology (Center City), Albert Einstein Medical Center, or SKCCC Mobile Prostate Cancer Screening community events. The biospecimens samples collected for this study will be used for research including conducting molecular analysis to identify biomarkers that are associated with prostate cancer prognosis.

Patients presented to the urology clinic or community prostate cancer screening events and will be approached to sign informed consent form. Consenting patients shall provide 15-50 ml of voided urine in a sterile container. The patient collection population will consist of these specific cohorts:

• Cohort 1 (PCa) Males 50-70 years of age N = 150

o Known to have prostate cancer (PCa) with any Gleason Score (Prognostic Grade Group, or PGG, Rating 1 to 5) without any treatment including surgery, radiation, or medication, who are scheduled for surgical excision with radical prostatectomy

• Cohort 2 (Normal) Males 50-70 years of age N = 125

• Normal control males
• Not known to have prostate cancer and have PSA </=1.5 ng/ml
• Excluded are patients with renal etiology of disease
• Cohort 3 (Benign Prostatic Hyperplasia, BPH) Males 50-70 years of age N = 100

o Patients with a BPH diagnosis, but no prostate cancer, having PSA </= 1.5 ng/ml within the past year

• Cohort 4 (Persistently Elevated, PE) Males 50-70 years of age N = 100

• Patients with a negative prostate biopsy resulted within the last 1 year from the day of consent
• Patients must have at least 2 PSA values greater than 2.5 ng/mL, with the most recent value being resulted within the last year from the day of consent, unless other approved by the PI
• Exclusion Criteria for this cohort remains:
• Patients with cancers along the GU tract, not including penile or testicular cancers
• Patients taking finasteride or dutasteride
• Patients providing a sample with microscopic or gross hematuria The urine samples will then be processed in the Dr. Thakur laboratory using the protocol established in the laboratory. Dr. Thakur and the lab personnel shall be unblinded to the donor condition and their group to which the sample belongs.

Results shall be recorded and then corroborated retrospectively to the patient's condition.

• Cohort 5 (STEAP1-Prostate Cancer GG1-GG5) Male participants with pathology-confirmed prostate cancer (Gleason Grade Groups 1-5). Urine samples are analyzed for six transmembrane epithelial antigens of prostate 1 (STEAP1) expression using fluorescent peptide imaging assay. STEAP1 fluorescence intensity and receptor density are correlated with tumor grade and disease aggressiveness.
• Cohort 6 (STEAP1--Age-Matched Non-Malignant) Age-matched male participants without known prostate malignancy. Urine samples are analyzed for STEAP1 expression to establish baseline fluorescence intensity and assay specificity in non-cancerous controls.

Individuals must meet all the following inclusion criteria in order to be eligible to participate in the study:

• Provide signed and dated informed consent form (ICF)
• Male
• Patients must be 50-70 years of age (VPAC) or 50-75 (STEAP1)
• Willing to comply with all study procedures VPAC Specific Aim 1 - Prostate Cancer, PCa (N = 150)
• Known diagnosis of untreated prostate cancer, scheduled for robotic prostatectomy
• No prior treatment (surgery, radiation, or medical therapy) Specific Aim 1.1 - Normal PSA (N = 125)
• PSA < or = 1.5 ng/ml within the last year
• No diagnosis or suspicion of cancer anywhere along the genitourinary tract
• No history of BPH Prostate VPAC Version 8.0 Protocol 20G.196 20 June 2025 Based on SKCC Interventional Protocol Template v.20170209 page 20 of 31 Specific Aim 1.2 - Benign Prostatic Hyperplasia, BPH (N = 100)
• PSA < or = 1.5 ng/ml within the last year
• Previous history of PSA >1.5 ng/ml are still eligible if they underwent surgery for the treatment of BPH and had a subsequent decrease in PSA below 1.5 ng/m
• Has a diagnosis of BPH, BOO, or LUTS Specific Aim 2 - Persistently Elevated PSA, PE (N = 100)
• Patients with a negative prostate biopsy within the last 1 year from the day of consent
• At least two elevated PSA values, defined as 2.5 ng/dL or greater, with the most recent result being within the last 1 year from the day of consent, unless otherwise approved by the PI
• HGPIN and ASAP are considered negative
• Previous biopsy results, if a repeat prostate biopsy patient, do not need to be available, there is also no preferred timeframe of previous biopsy (can be >1 year at time of consent) STEAP1 Specific Aim 1: To determine STEAPl receptor density as a function of PCa GGl to 5 using receptors specific immunohistochemistry Specific Aim 2: To determine STEAPl expression as a function of PCa GG, 1-5 using quantitative RtPCR.

An individual who meets any of the following criteria will be excluded from participation in this study:

• Subjects under the age of 50 or over the age of 70 (VPAC) or above 75 (STEAP1)
• Individuals with any cancers along the genitourinary tract (does not include penile or testicular cancers)
• Individuals taking finasteride or dutasteride, which decreases the PSA value
• Individuals with gross hematuria suspicious of bladder cancer