Expert Doctors: A Non-Invasive Urine Test Just “Changed the Game” for Prostate Screening

Affecting nearly 13% of American men, prostate cancer is the most prevalent male cancer aside from skin cancer. The primary screening method for prostate cancer is the PSA (prostate-specific antigen) test, a blood test that measures a protein produced by both healthy and cancerous prostate cells.

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Elevated PSA levels suggest the presence of prostate cancer, but these levels can also be elevated due to other conditions, such as prostatitis (inflammation of the prostate) or benign prostatic hyperplasia (enlargement of the prostate).

Prostate cancer varies widely in its progression: Some forms grow slowly and pose minimal risk, while others are aggressive and require immediate intervention. Historically, the challenge for doctors has been in determining which cases of prostate cancer are likely to spread without resorting to unnecessary biopsies. A prostate biopsy can be a painful experience, and some patients have discovered particular sensitivity when there’s a need for the clinician to collect multiple specimens for pathological examination.

To address this challenge on both the patient’s side and the doctor’s, University of Michigan Rogel Cancer Center researchers have developed a new diagnostic tool: The MyProstateScore2.0 (MPS2) test. This new prostate cancer urine test, covered in the April 2024 issue of the peer-reviewed American Medical Association journal JAMA Oncology, is designed to differentiate between aggressive and non-aggressive forms of prostate cancer and, by doing so, has the potential to improve the diagnosis and management of prostate cancer.

Here’s what the researchers discovered

The prostate cancer urine test assesses 18 genes linked to high-grade prostate cancer—cancers that are more likely to grow and spread. It targets cancers classified as Gleason 3+4=7 or Grade Group 2 (GG2) or higher. The Gleason score is a grading system used to assess the severity of prostate cancer, where higher scores indicate more severe forms of the disease.

John T. Wei, MD, co-senior study author, chief of urology, and professor at Michigan Medicine, discussed this evolution of prostate cancer diagnosis in a press release: “Our standard test [PSA test] is lacking in terms of its ability to clearly identify those who have significant cancer. Twenty years ago, we were looking for any kind of cancer. Now we realize that slow-growing cancer doesn’t need to be treated. All of a sudden, the game changed.” Dr. Wei went on to help highlight what this means for patients: “Nobody wants to say, ‘Sign me up for another biopsy.’ We are always looking for alternatives and this is it.”

This isn’t the first prostate cancer urine test developed by Dr. Wei and his colleagues. A previous version was created nearly a decade ago but failed to distinguish high-grade cancers. To develop the MPS2 test, the team analyzed over 58,000 genes and narrowed them down to 18, reliably indicating the presence of more serious disease. They then tested MPS2 on over 800 urine samples.

The results were remarkable: The MPS2 test accurately identified GG2 or higher cancers and was nearly 100% effective at ruling out Grade Group 1 (GG1) cancers, which are less likely to progress and cause harm. “If you’re negative on this test, it’s almost certain that you don’t have aggressive prostate cancer,” explains Arul M. Chinnaiyan, MD, PhD, professor of pathology and professor of urology at Michigan Medicine.

How patient care for prostate cancer is improved

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The researchers found that MPS2 testing can help avoid up to 41% of unnecessary prostate biopsies, compared to just 11% with PSA testing alone. This is especially beneficial for men who have already undergone biopsies and face the prospect of additional procedures due to rising PSA levels. MPS2 testing improves patient care and aligns medical interventions more closely with individual health needs, marking a major step forward in the management of prostate cancer.

If you’re wondering whether this prostate cancer screening will be available to you, for now the University of Michigan shares: “MPS2 is currently available through LynxDx, which is University of Michigan spin-off company that has an exclusive license from the university to commercialize MPS2. Patients interested in learning more can call the Michigan Medicine Cancer AnswerLine at 800-865-1125.”