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A new urine test may soon revolutionize how physicians monitor men with low-risk prostate cancer, providing a much less invasive method to determine if the disease is progressing into a more dangerous stage. Researchers have shown that this test outperforms traditional approaches such as PSA blood tests and MRI scans when it comes to identifying patients who genuinely need repeat biopsies.
Published in The Journal of Urology, the study indicates that the test could help many men avoid unnecessary procedures while still effectively detecting cancers that become more aggressive and require treatment.
Prostate cancer remains one of the most prevalent cancers among men worldwide. In many cases, the cancer grows slowly and may never pose a serious threat during a person’s lifetime. As a result, healthcare providers often recommend “active surveillance,” which involves closely monitoring the cancer rather than jumping straight to surgery or radiation therapy.
This approach aims to prevent the side effects associated with aggressive treatments, including urinary problems, bowel issues, and sexual dysfunction. However, active surveillance can be stressful, involving frequent testing and repeated prostate biopsies, which require inserting needles into the prostate to collect tissue. While biopsies are common, they can cause pain, bleeding, infections, anxiety, and discomfort.
Currently, doctors rely on PSA levels, MRI scans, and biopsies to monitor for signs that prostate cancer might be worsening. Unfortunately, these methods are not foolproof—elevated PSA levels can be caused by factors other than cancer, and MRI scans don’t always clearly reveal dangerous changes.
The innovative test, called MyProstateScore 2.0-Active Surveillance (MPS2-AS), could provide a better solution. Instead of just blood tests or imaging, it analyzes urine samples for biomarkers associated with more aggressive cancer forms.
Vanderbilt Health researchers tested the urine test on over 300 men diagnosed with low-grade prostate cancer (Grade Group 1) who were already on active surveillance. The goal was to determine if the test could accurately identify those who had upgraded to higher-grade cancers that need treatment, as well as those who could safely avoid another biopsy.
Results were promising: the test correctly identified high-grade prostate cancer in 97% of cases. Notably, if a patient’s urine test was negative, there was only about a 1% chance they actually had a more dangerous cancer—highlighting the test’s high negative predictive value. This means it’s highly reliable in reassuring both doctors and patients that serious cancer is unlikely.
Using this test, researchers estimate that up to 64% of unnecessary repeat biopsies could be avoided for men under active surveillance. Dr. Jeffrey Tosoian, an assistant professor of urology at Vanderbilt and the study’s lead author, commented that these findings suggest many men might skip invasive biopsies without missing critical cancer developments.
The grading system for prostate cancer—using the Gleason score and Grade Group—helps estimate how aggressive the cancer may be. Higher scores typically relate to a greater likelihood of spread. Participants in this study initially had low-risk cancers with a Gleason score of 6 and Grade Group 1. The focus was on detecting whether the cancer had upgraded to Grade Group 3 or higher, which usually warrants treatment.
This research is especially significant because many men on active surveillance grapple with anxiety and uncertainty about whether their cancer might worsen unexpectedly. The urine test offers a non-invasive way to reduce physical discomfort and emotional stress, replacing repeated needle biopsies with a simple urine sample.
The findings also mark progress toward more personalized cancer management. Instead of a one-size-fits-all strategy, doctors could someday use such precise tools to determine who truly needs invasive procedures and who can safely be observed.
The research team is now exploring whether similar testing could assist in other aspects of prostate cancer care, including monitoring for recurrence after treatment. Overall, the study emphasizes a delicate balance in prostate cancer screening and management—aiming to catch dangerous cancers early while avoiding unnecessary harm from overtesting and overtreatment.
Though more validation in larger, diverse populations is necessary before the test becomes routine, experts believe these early results are encouraging and could greatly improve future prostate cancer monitoring practices.
For those interested in prostate health updates, recent studies explore bacteria linked to aggressive prostate cancer, new strategies to treat advanced stages, methods to reduce the risk of disease spread, and the effectiveness of combination therapies that improve survival in metastatic cases.
The study was published by Vanderbilt University.
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