A Urine Test May ID the Deadliest Prostate Cancers

ACS Professor Dr. Chinnaiyan led the development of a new urine test to identify whether a man has a high-grade prostate cancer.

The Challenge

Prostate cancer is the most commonly diagnosed cancer and a leading cause of death from cancer worldwide. Research has shown that screening for prostate cancer by measuring PSA (prostate-specific antigen) levels in the blood saves a substantial number of men from dying from the disease. However, PSA testing also has several potential harms.

Test results can lead doctors to recommend unneeded invasive biopsies in men who don’t have cancer or to diagnose cancers that grow very slowly (called low-grade, indolent cancers) and don’t need to be treated.

PSA blood tests don’t always identify one of the most aggressive types called high-grade prostate cancers. While PSAs can identify too many slow growing cancers, they don’t always identify high-grade tumors that are the fastest growing and the most likely to spread.

For men with a high PSA level, current clinical guidelines from the National Comprehensive Cancer Network (NCCN) guide physicians to first order an mpMRI (multiparametric magnetic resonance imaging) to scan for significant high-grade tumors.

mpMRIs don’t give all the answers and aren’t available and they are not easily accessible to men in all parts of the US? One problem is that if an mpMRI is negative (doesn’t find a high-grade tumor), a high-grade cancer cannot be definitively ruled out. So, in those cases, a biopsy is still needed.

If mpMRI isn’t available, the guidelines call for biomarker testing to determine the risk of having prostate cancer before a biopsy. Currently, there are 6 tests available to look for biomarkers in the blood or urine, with each including up to 1-3 markers of prostate cancer at any grade.

Adding these biomarker tests to a PSA test is better for finding a high-grade cancer than PSA testing alone, but this limited number of markers cannot accurately capture the diverse drivers of lethal disease.

The Research

One of our American Cancer Society (ACS) Professors, Arul M. Chinnaiyan, MD, PhD, led a study published in JAMA Oncology describing his team’s efforts to improve the accuracy of biomarker tests to identify high-grade prostate cancer tumors.

He and fellow researchers at the University of Michigan, as well as collaborators at other institutions, were the first scientists to identify biomarkers with new molecules at levels that only high-grade cancers make. Then they developed a new urinary test with 17 markers of cancer.

Clinically, use of this test would have safely avoided unnecessary additional testing with imaging or biopsy in 35% to 51% of patients while still finding the high-grade cancers early, allowing these aggressive prostate cancers to be treated before they’ve spread.

We are excited that this test, called MyProstateScore 2 (MPS2), is now available to patients in consultation with their physician.”

Arul M. Chinnaiyan, MD, PhD

ACS Professor

Hicks Endowed Professor of Pathology at the University of Michigan Medical School and Medical Investigator at Howard Hughes Medical Institute

Why It Matters

The increases in advanced prostate cancer incidence has public health implications, as later stages of prostate cancer are linked with multiple health issues and premature death. Future studies are needed to better understand the reasons for the rising trends in more advanced stages of prostate cancer and the disproportionately high burden of the disease in Black men.