A less invasive option for watching low-risk prostate cancer
A new urine test may change how doctors monitor men with low-risk prostate cancer who are on active surveillance. According to a study published in The Journal of Urology, the test performed better than PSA-based testing and MRI in this setting and could have avoided up to 64% of unnecessary repeat biopsies while still detecting higher-grade cancers that warrant treatment.
The test, called MyProstateScore 2.0-Active Surveillance, or MPS2-AS, was evaluated in more than 300 patients with Grade Group 1 prostate cancer. The result addresses one of the most persistent burdens in active surveillance: the need for repeated prostate biopsies every two to three years because current noninvasive tools do not reliably rule out clinically important progression.
Why surveillance still feels invasive
Active surveillance is widely used because many low-risk prostate cancers are unlikely to cause harm if watched carefully rather than treated immediately. That approach helps patients avoid unnecessary surgery or radiation. But surveillance comes with its own costs. Some patients later prove to have higher-risk disease, so doctors must keep checking for signs of upgrading.
Because PSA testing and imaging have limits, repeat biopsy remains central to the current model. Biopsies can be uncomfortable, invasive, and anxiety-producing. A test that helps determine who really needs one, and who can safely avoid it, would therefore fill a major gap.
That is the problem MPS2-AS is trying to solve. Rather than replacing monitoring altogether, it aims to make monitoring more selective and more precise.
What the study found
Lead author Jeffrey Tosoian of Vanderbilt Health said the findings suggest the urine test can reduce the need for invasive biopsies without compromising timely detection of higher-grade cancers that require treatment. That is the key claim from the study, and it is what makes the result clinically significant.
The source states that use of the test to decide whether a patient needed a repeat monitoring biopsy would have avoided up to 64% of unnecessary biopsies. At the same time, the study reported that detection of higher-grade cancers would remain timely. In other words, the potential benefit is not simply fewer procedures. It is fewer procedures without losing sight of the cases where disease has become more aggressive.
This distinction matters. Many noninvasive cancer tests are attractive because they reduce burden, but they are only useful if they do not meaningfully delay recognition of disease that needs action. The authors present MPS2-AS as a step forward because it may do both jobs at once: spare some patients from needless interventions while still flagging the men who need closer follow-up.
How it compares with existing tools
The source describes the test as outperforming both PSA-based testing and MRI for this surveillance use case. That is a strong comparison because both tools are already embedded in modern prostate cancer management. PSA remains one of the most familiar markers in urology, while MRI has become an important way to refine risk and target biopsies.
Yet neither has eliminated the need for routine repeat biopsy in men on surveillance. The reason is straightforward: each has blind spots. That is why active surveillance protocols still rely on tissue sampling despite efforts to reduce procedure frequency. The study’s importance lies in suggesting that a urine-based assay may offer enough accuracy to change that balance.
The researchers noted that other noninvasive tests have been studied in active surveillance, but none have shown enough accuracy to rule out repeat biopsies. The team said it is optimistic that these results represent a meaningful advance for the field and, most importantly, for patients.
What comes next
The findings do not mean biopsy disappears from prostate cancer surveillance. They do suggest a future in which biopsy becomes more targeted and less routine. That would be a meaningful shift in care, especially for men expected to spend years in monitoring programs.
For clinicians, the question now becomes whether these results hold up in broader use and how quickly they can be integrated into real-world decision-making. For patients, the appeal is obvious: a noninvasive urine test that may reduce the number of times they undergo an invasive procedure while preserving the core safety goal of surveillance.
If that promise is confirmed in practice, the value of MPS2-AS will not be in replacing medical judgment. It will be in improving it. Active surveillance works best when it separates men who can safely keep watching from those whose disease has changed. A test that sharpens that line could make surveillance less burdensome and more precise at the same time.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
