Urine Test May Improve Active Surveillance Monitoring in Prostate Cancer

A novel urine-based test may significantly reduce the need for repeat biopsies among patients with low-risk prostate cancer undergoing active surveillance, according to findings published in The Journal of Urology.¹ Investigators reported that the test, MyProstateScore 2.0–Active Surveillance (MPS2-AS), outperformed both prostate-specific antigen (PSA)-based approaches and multiparametric magnetic resonance imaging (mpMRI) in identifying patients at risk for disease progression.^1,2

Active surveillance is widely used in patients with low-risk prostate cancer, particularly those with Gleason score 6 or Grade Group (GG) 1 disease, to help avoid unnecessary treatment and preserve quality of life.² Rather than immediately pursuing surgery or radiation, patients are closely monitored over time using PSA testing, imaging, and repeat biopsies. However, because some cancers later progress into more aggressive disease, surveillance protocols typically require invasive biopsies every 2 to 3 years.^2,3

MPS2-AS Outperformed mpMRI in Detecting Disease Upgrading

Researchers developed and externally validated MPS2-AS, a non-digital, rectal exam-free urine test designed to determine whether a repeat biopsy is necessary in patients undergoing active surveillance. The study included 330 patients with GG1 prostate cancer across 11 clinical practices who were scheduled for active surveillance biopsies.¹

Among the study population, 85% underwent pre-biopsy mpMRI. Of these patients, 46% had Prostate Imaging Reporting and Data System (PI-RADS) 1-2 findings, 15% had PI-RADS 3 lesions, and 39% had PI-RADS 4-5 lesions. Biopsy results ultimately showed that 9.4% of patients upgraded to GG3 or greater disease, while 37% upgraded to GG2 or higher.¹

The urine assay demonstrated stronger diagnostic accuracy than mpMRI for both clinically significant endpoints. According to the investigators, MPS2-AS achieved an area under the curve (AUC) of 0.82 for detecting GG3 or higher disease compared with 0.73 for mpMRI. For GG2 or greater upgrading, the assay demonstrated an AUC of 0.74 compared with 0.64 for mpMRI.¹

Importantly, researchers found that use of MPS2-AS could have avoided approximately 64% of unnecessary biopsies while missing only 3.2% of GG3 or greater cancer upgrades. By comparison, relying on PI-RADS 3 or higher findings from mpMRI would have missed 18% of GG3 upgrades while avoiding fewer unnecessary biopsies overall (50%).¹

Reducing Reliance on Invasive Monitoring

According to lead study author Jeffrey Tosoian, MD, MPH, assistant professor in the Department of Urology at Vanderbilt Health, the findings support the potential role of MPS2-AS as a noninvasive surveillance tool.²

“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,” Tosoian explained in a statement.²

The investigators also noted that test performance remained consistent across clinically relevant patient subgroups, including both confirmatory and surveillance biopsy populations as well as Black and non-Black patients.¹

Although mpMRI has improved prostate cancer monitoring in recent years, limitations remain regarding cost, accessibility, and the ability to consistently rule out clinically significant disease.⁴ Researchers emphasized that a highly accurate urine-based biomarker could help reduce patient burden associated with repeated biopsies and serial imaging.¹

Future Implications for Active Surveillance

Prostate cancer grading systems, including Gleason scores and GGs, are used to estimate tumor aggressiveness based on microscopic appearance.³ Higher-grade cancers are more likely to grow rapidly or spread, making early identification of upgrading critical during surveillance.

Pharmacists are often involved in counseling patients on surveillance schedules, treatment expectations, and management of anxiety related to repeat testing and biopsies. A validated urine-based monitoring strategy could help pharmacists reinforce adherence to surveillance protocols while also helping patients better understand when invasive procedures may or may not be necessary.

Investigators concluded that MPS2-AS represents a meaningful advancement in noninvasive monitoring for prostate cancer and may ultimately reduce dependence on both scheduled biopsies and serial mpMRI examinations.¹ Future studies will evaluate the assay’s role in additional areas of prostate cancer management, including recurrence monitoring after treatment.²

REFERENCES

1. Tosoian JJ, Meyers JI, Moore B, et al. Non-Invasive Urine Test Predicts Grade Group Upgrading in Patients on Active Surveillance for Prostate Cancer: Multisite Validation and Comparison with MRI. J Urol. Published online April 28, 2026. doi:10.1097/JU.0000000000005095

2. The ASCO Post Staff. Noninvasive Urine Test May Provide Grade Group information in Patients with Prostate Cancer. The ASCO Post. Published May 12, 2026. Accessed May 13, 2026. https://ascopost.com/news/may-2026/noninvasive-urine-test-may-provide-grade-group-information-in-patients-with-prostate-cancer/

3. Prostate Cancer Treatment (PDQ)- Patient Version. National Cancer Institute. Published December 20, 2024. Accessed May 13, 2026. https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq

4. Tests to Diagnose and Stage Prostate Cancer. American Cancer Society. Published March 21, 2025. Accessed May 13, 2026. https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html