Urine test may reduce prostate MRI and biopsy use

A urine test developed at Vanderbilt Health may reduce the need for repeat prostate MRI and biopsies in men undergoing active surveillance for low-risk prostate cancer.

The test, called MyProstateScore 2.0 Active Surveillance (MPS2-AS), was evaluated in more than 300 patients with Grade Group 1 prostate cancer. Vanderbilt said the test performed better than PSA-based testing and MRI for monitoring low-risk disease.

Use of MPS2-AS to guide repeat monitoring biopsies would have avoided up to 64% of unnecessary biopsies while maintaining timely detection of higher-grade cancers, according to the study published in The Journal of Urology.

Active surveillance is commonly used to monitor men with low-risk prostate cancer and avoid treatment for cancers unlikely to cause harm. Because some cancers later upgrade to higher-risk disease, patients often undergo repeat biopsies every 2 to 3 years.

In patients previously diagnosed with low-grade cancer, MPS2-AS correctly predicted the presence of high-grade cancer in 97% of cases. The test also had a 99% negative-predictive value for Grade Group 3 or higher upgrading, meaning a negative result was associated with a 1% chance of high-grade cancer being found on biopsy.

Jeffrey Tosoian, MD, MPH, assistant professor in Vanderbilt Health’s Department of Urology, said the findings suggest the urine test can “reduce the need for invasive biopsies” without delaying detection of cancers that require treatment.

Compared with Prostate Imaging Reporting and Data System (PI-RADS) scoring, MPS2-AS showed higher accuracy for upgrading to both Grade Group 2 and Grade Group 3 disease.

Prebiopsy urine testing would have avoided 64% of unnecessary biopsies while missing 3% of Grade Group 3 upgrades. By comparison, PI-RADS scoring would have avoided 50% of unnecessary biopsies while missing 18% of Grade Group 3 or higher upgrades, the article noted.

Performance was consistent across clinically relevant subgroups, according to the authors. They concluded that noninvasive monitoring with MPS2-AS could reduce the need for scheduled biopsies and serial multiparametric MRI.

The research was supported by the National Institutes of Health. Next steps include studying whether the testing approach can be used in other parts of prostate cancer care, including recurrence detection after treatment.