Men diagnosed with low‑risk prostate cancer are often advised to choose active surveillance rather than immediate treatment. This approach avoids unnecessary surgery or radiotherapy, but it relies on regular testing to ensure the cancer has not become more aggressive.
A new study suggests that a urine‑based test could make this monitoring safer and less invasive by reducing the need for repeat prostate biopsies.
Researchers report that the test performed better than standard PSA blood tests and prostate MRI scans in identifying which men were unlikely to have developed higher‑grade cancer.
Why monitoring prostate cancer is challenging
Prostate cancer is commonly graded using two related systems. The Gleason score, ranging from 6 to 10, and the Grade Group system, ranging from 1 to 5, describe how abnormal the cancer cells look under a microscope. Lower numbers indicate slower‑growing cancers that are less likely to cause harm, while higher numbers suggest a more aggressive disease.
Many men are diagnosed with Grade Group 1 cancer, the lowest category. For these men, active surveillance is widely recommended. This involves regular PSA testing, imaging scans and periodic prostate biopsies, usually every two to three years.
Biopsies can be uncomfortable and carry small risks of bleeding or infection, but they are currently used because other tests have limited accuracy in ruling out cancer progression.
What the new study found
The new research, published in The Journal of Urology, evaluated a urine test called MyProstateScore 2.0 – Active Surveillance (MPS2‑AS). The study included more than 300 men who were already on active surveillance for Grade Group 1 prostate cancer.
The researchers compared the urine test with PSA‑based measures and MRI scans to see how well each approach identified men whose cancer had progressed to higher‑grade disease.
The key finding was that MPS2‑AS correctly identified 97% of men who were found on biopsy to have Grade Group 3 or higher cancer. Importantly, the test had a negative predictive value of 99% for these higher‑grade cancers.
In practical terms, this means that men with a negative test result had only a 1% chance of having a more aggressive cancer detected on biopsy.
Based on these results, the researchers estimated that using the urine test to guide decisions about repeat biopsies could have avoided up to 64% of unnecessary biopsies, while still detecting cancers that required treatment in a timely way.
How the urine test works
The test analyses urine samples for a combination of genetic markers linked to prostate cancer behaviour. These markers reflect changes in gene activity associated with more aggressive disease.
Measuring specific RNA signals from these cells allows the test to estimate the likelihood that a higher‑grade cancer is present, even if standard blood tests or imaging appear reassuring. The urine contains prostate‑derived RNA. The test technically measures expression of selected prostate cancer genes using real‑time PCR. Gene activity is quantified using cycle threshold (Ct) values.
Rather than replacing all other tests, the urine analysis is designed to add information that helps doctors decide whether a biopsy is truly needed.
How strong is the evidence?
The study was conducted in people, across multiple clinical sites, which strengthens confidence in the findings. The number of participants was moderate, and all were already on active surveillance, making the results directly relevant to this group.
However, the test does not eliminate uncertainty entirely. A small risk of missed higher‑grade cancer remains, and longer‑term follow‑up will be needed to confirm that delaying or avoiding biopsies based on the test does not affect outcomes such as survival or cancer spread.
The research was funded and reported through academic centres, but broader real‑world studies will be important before widespread adoption.
What this means for patients
For men on active surveillance, the findings suggest a potential way to reduce the number of invasive biopsies without compromising safety. A non‑invasive urine test could offer reassurance when results are negative and help focus biopsies on those most likely to benefit.
This research does not change current clinical guidelines yet. Decisions about monitoring should still be made with a specialist, taking into account PSA levels, imaging, biopsy history and individual preferences. Always consult your healthcare providers for medical advice.
If confirmed in further studies, urine‑based testing could become a useful addition to prostate cancer surveillance, alongside PSA testing and MRI. It may also reduce healthcare costs and the burden of repeated procedures for patients.
The research team plans to explore whether similar testing approaches could help in other areas of prostate cancer care, such as detecting cancer recurrence after treatment.
A cautious step forward
Active surveillance aims to balance safety with quality of life. This study suggests that better non‑invasive tools may help achieve that balance more effectively.
While more evidence is needed before practice changes, the findings point towards a future where fewer men undergo unnecessary biopsies, without losing sight of cancers that need prompt treatment.
The post A New Urine Test Performs Better Than MRI and PSA for Low-Risk Prostate Cancer Monitoring first appeared on PP Health Malaysia.
