A Non-Invasive Urine Test Could Reduce Unnecessary Prostate Biopsies by 64%

For men diagnosed with low-grade prostate cancer, active surveillance — a careful monitoring approach that avoids immediate treatment — has become a widely accepted and evidence-backed strategy. The idea is straightforward: not every prostate cancer needs to be treated right away, and regular monitoring can catch any concerning changes before they become serious.

The challenge has always been figuring out which monitoring tools work best. Right now, that typically means repeat biopsies and MRI scans on a scheduled basis — procedures that are uncomfortable, costly and not without risk. A new study published in The Journal of Urology suggests there may be a better way: a simple urine test that does not even require a rectal exam.

What the Study Did

A team of investigators developed and externally validated a urine-based biomarker test called MyProstateScore 2.0 Active Surveillance, or MPS2-AS, across 11 clinical practices involving 330 men with low-grade prostate cancer who were already on active surveillance. The goal was to determine whether the test could accurately predict which men had experienced disease upgrading (meaning their cancer had progressed to a more concerning grade) and whether it could reliably identify who actually needed a biopsy and who could safely skip one.

Crucially, the test was compared head-to-head against multiparametric MRI, or mpMRI, which is currently one of the most widely used imaging tools for monitoring men on active surveillance.

What the Results Showed

The urine test outperformed MRI across every key measure. MPS2-AS achieved a higher accuracy score than mpMRI for detecting both moderate and high-grade cancer progression. In practical terms, using MPS2-AS before a biopsy would have allowed doctors to safely skip 64% of unnecessary biopsies, while missing only 3.2% of cases where the cancer had progressed to a more serious grade. By comparison, using MRI alone would have avoided fewer unnecessary biopsies and missed 18% of significant cancer upgrades — a meaningful difference that could have real consequences for patients.

The test also performed consistently across different patient groups, including Black and non-Black men — an important finding given that Black men face a disproportionately higher risk of aggressive prostate cancer and have historically been underrepresented in prostate cancer research.

What This Means for Patients

For any man currently on active surveillance for prostate cancer, this research points toward a future where the monitoring process is less invasive, less stressful and more precise. Instead of undergoing a scheduled biopsy every one to three years regardless of individual risk, a urine test collected at a routine visit could help determine whether a biopsy is actually warranted — and potentially whether an MRI is even needed.

The implications go beyond convenience. Biopsies carry real risks, including infection, pain and anxiety. Reducing unnecessary procedures means reducing unnecessary harm while still catching the cases that genuinely need attention. A test that is noninvasive, does not require a rectal exam and can be collected at any clinical setting also has significant potential to improve access and equity in prostate cancer monitoring.

Investigators note that these results indicate MPS2-AS could eventually reduce the need for both scheduled biopsies and serial MRI in active surveillance, a shift that would be welcome news for patients and clinicians alike.

“For patients undergoing monitoring of low-grade prostate cancer, these findings suggest that use of the urine test can reduce the need for invasive biopsies without compromising prompt detection of higher-grade cancers that require treatment,” said lead investigator Jeffrey Tosoian, M.D., M.P.H., assistant professor in the Department of Urology at Vanderbilt Health.