PROSTATE cancer (PCa) screening through serum PSA testing has been shown to significantly reduce mortality rates. The long-term Goteborg randomized screening trial demonstrated that inviting 221 men to screening could prevent one PCa-related death, a statistic that compares favourably with screening for other prevalent cancers. However, traditional PSA screening has drawbacks, including unnecessary biopsies and overdiagnosis of indolent, low-grade cancers. To mitigate these issues, contemporary guidelines recommend incorporating MRI or biomarker testing before proceeding with biopsy.
MRI-targeted biopsy of abnormal regions has improved the detection of clinically significant PCa (grade group ≥ 2 [GG ≥ 2]) while reducing overdiagnosis of low-risk GG1 disease. However, widespread implementation of MRI is hindered by resource limitations, expert-dependent interpretation, and financial costs. This has led to a growing interest in blood- and urine-based biomarkers to refine patient selection for MRI and biopsy. Among these biomarkers, the MyProstateScore 2.0 (MPS2) test has emerged as a promising tool.
MPS2 utilises a urine sample collected post-digital rectal examination (DRE) to measure the expression of 18 genes associated with high-grade prostate cancer. In external validation studies, MPS2 testing reduced unnecessary biopsies by 35% to 51% while maintaining a 95% detection rate of GG ≥ 2 cancers. However, given patient discomfort with DRE and the rise of telehealth consultations, researchers have validated MPS2 for use with urine samples obtained without prior DRE.
To enhance clinical flexibility, MPS2 can be performed with varying levels of clinical data input, ensuring that clinicians receive the most informative results based on available patient data. Importantly, MPS2 outperforms traditional predictive models such as the PCPTrc, particularly in the repeat biopsy setting. For instance, in detecting 92% of GG ≥ 2 cancers, MPS2 could reduce unnecessary biopsies by 36% to 42%, compared with 13% using the PCPTrc.
By offering a non-invasive, highly specific approach to PCa screening, MPS2 enhances clinical decision-making while reducing patient burden. Future research should focus on optimising its integration with MRI and assessing its performance across diverse patient populations. With further validation, MPS2 may become a cornerstone of modern PCa diagnostic pathways.
Katie Wright, EMJ
Reference
Tosoian JJ et al. Clinical validation of MyProstateScore 2.0 testing using first-catch, non-digital rectal examination urine. J Urol. 2025;DOI:10.1097/JU.0000000000004421.
