A new urine test may soon change how doctors monitor men with low-risk prostate cancer, offering a much less invasive way to check whether the disease is becoming dangerous.
Researchers found that the test performed better than common methods such as PSA blood tests and MRI scans when deciding which patients truly needed repeat biopsies.
The study, published in The Journal of Urology, suggests that the test could help many men avoid unnecessary procedures while still catching cancers that become more aggressive and require treatment.
Prostate cancer is one of the most common cancers in men worldwide. In many cases, the disease grows very slowly and may never cause serious harm during a person’s lifetime. Because of this, doctors often recommend “active surveillance” instead of immediate treatment for men with low-risk prostate cancer.
Active surveillance means doctors closely monitor the cancer over time rather than rushing into surgery or radiation therapy. This approach can help patients avoid side effects from treatment, such as urinary problems, bowel issues, and sexual dysfunction.
However, active surveillance can also be stressful and uncomfortable for patients because it usually involves regular testing and repeated prostate biopsies every few years. During a biopsy, doctors insert needles into the prostate gland to collect tissue samples. While biopsies are common, they can cause pain, bleeding, infection, anxiety, and discomfort.
Doctors currently use PSA blood tests, MRI scans, and biopsies to watch for signs that prostate cancer may be becoming more aggressive. But these methods are not perfect. PSA levels can rise for many reasons besides cancer, and MRI scans do not always clearly show dangerous changes.
The new test, called MyProstateScore 2.0-Active Surveillance, or MPS2-AS, may offer a better solution. Instead of using blood or imaging alone, the test analyzes urine samples for signs linked to more aggressive prostate cancer.
Researchers from Vanderbilt Health tested the urine test in more than 300 men who had already been diagnosed with low-risk prostate cancer classified as Grade Group 1. These patients were already on active surveillance programs.
The researchers wanted to know whether the urine test could accurately identify which patients were developing higher-grade cancers that needed treatment and which patients could safely avoid another biopsy.
The results were very encouraging. The test correctly identified high-grade prostate cancer in 97% of cases. Researchers also found that if the urine test result was negative, patients had only about a 1% chance of actually having dangerous higher-grade cancer.
This is known as a high negative predictive value. In simple terms, it means the test was extremely reliable at reassuring doctors and patients that serious cancer was unlikely to be present.
Researchers estimated that using the urine test could avoid up to 64% of unnecessary repeat biopsies in men being monitored for low-risk prostate cancer.
Dr. Jeffrey Tosoian, assistant professor in the Department of Urology at Vanderbilt Health and lead author of the study, said the findings show that many men may be able to safely avoid invasive biopsies without missing important cancer changes.
The grading system used in prostate cancer is designed to estimate how aggressive the cancer may be. Doctors use the Gleason score and Grade Group system to examine how abnormal the cancer cells appear under a microscope. Higher numbers generally mean the cancer is more aggressive and likely to spread.
Men in this study had low-risk cancers with a Gleason score of 6 and Grade Group 1 at the beginning. The researchers focused especially on detecting cancers that had upgraded to Grade Group 3 or higher, since these cancers are much more likely to require treatment.
One reason this research is attracting attention is because many men on active surveillance live with ongoing worry about repeat biopsies and uncertainty about whether their cancer may suddenly worsen.
The urine test could help reduce both physical and emotional stress for patients. A simple urine sample is much easier and safer than undergoing repeated needle biopsies.
Researchers say the findings also represent progress toward more personalized cancer care. Instead of treating all patients the same way, doctors may eventually use more precise tools to decide who truly needs invasive procedures and who can safely avoid them.
The research team is now studying whether the same testing approach could help in other parts of prostate cancer care, including checking whether cancer returns after treatment.
The findings are important because prostate cancer screening and monitoring have long been difficult balancing acts. Doctors want to avoid missing dangerous cancers, but they also want to avoid unnecessary procedures that may cause harm without improving outcomes.
This study suggests the new urine test may help solve part of that problem. The test appears highly accurate at identifying patients who are unlikely to have dangerous cancer progression.
Still, the study has some limitations. More research will be needed in larger and more diverse patient groups before the test becomes widely used. Researchers will also need to study how well the test performs over many years in real-world medical settings.
Even so, experts believe the findings are promising and could lead to major improvements in how prostate cancer is monitored in the future.
If you care about prostate cancer, please read studies about 5 types of bacteria linked to aggressive prostate cancer, and new strategy to treat advanced prostate cancer.
For more information about prostate cancer, please see recent studies about new way to lower risk of prostate cancer spread, and results showing three-drug combo boosts survival in metastatic prostate cancer.
The study was published in The Journal of Urology.
Source: Vanderbilt University.
