Chapters
0:49 What is the MiPS2 test and how does it work?
2:14 Can urine tests be used as a partial substitute for biopsies?
4:52 How does the 95% accuracy rate of urine tests affect the screening process?
7:17 What percentage of cancer is missed by different screening methods?
9:25 Can a PSMA scan cover the blind spots of an MRI?
9:58 Does MiPS2 function similarly to other urine tests?
11:15 Are urine tests helpful for those who don't have access to an MRI?
12:02 Is there much in the way of useful reporting data related to MiPS2?
13:43 Can PSA density provide information about the potential presence of cancer?
14:50 Are urine tests helpful for patients with more standard PSA levels?
16:46 Alex's conclusions
Prostate Cancer Screening: Beyond PSA
In the process of screening for prostate cancer, prostate-specific antigen (PSA) testing is often the first step. However, when PSA levels are elevated, additional tests may be necessary to clarify the risk. One such tool is the MIPS2 urine test, which can provide more nuanced insights into whether a patient may have a clinically significant form of prostate cancer.
Today’s discussion with Dr. Mark Scholz—a medical oncologist with over 30 years of experience focused solely on prostate cancer—explores how MIPS2 works, its benefits and drawbacks, and how it fits into a broader screening strategy.
Why Consider MIPS2?
PSA testing has been a game-changer, but it comes with limitations. Elevated PSA levels may stem from several causes including:
- Prostate infection
- Benign prostatic hyperplasia (BPH)
- Low-grade, non-threatening cancers
- High-grade, consequential cancers
Because PSA is non-specific, there's a need for follow-up tools that can refine risk assessments. MIPS2 helps by analyzing genetic markers in urine, offering a more precise estimation of whether a significant cancer is present.
The Problem with Overdiagnosis
One of the major criticisms of PSA screening is overdiagnosis and overtreatment. Men are sometimes treated for slow-growing cancers that would never have harmed them. On the flip side, early detection of aggressive cancers saves lives. The goal is to differentiate between these scenarios more accurately—and that’s where urine tests like MIPS2 come into play.
Can MIPS2 Reduce the Need for Biopsies?
Many men are reluctant to undergo digital rectal exams, biopsies, or even PSA tests. MIPS2 may offer a compelling middle step. According to Dr. Scholz, roughly one-third of men with elevated PSAs who take the MIPS2 test receive favorable results that suggest with 95% confidence that a biopsy would not find high-grade cancer. This can potentially spare them the discomfort and risks of unnecessary biopsies.
The MRI Factor: When and Why to Use It
Dr. Scholz notes that at his practice, they often skip urine tests altogether in favor of an MRI, which is increasingly covered by insurance and widely accessible. Though MRIs can be inconvenient or challenging for those with claustrophobia, they offer strong diagnostic accuracy with no radiation exposure.
For men over 70 or 75—where policies often recommend skipping PSA altogether—urine tests may be an acceptable alternative. Older men are less likely to suffer fatal outcomes from prostate cancer due to its slow progression, making the 5% false negative rate more tolerable.
Understanding Diagnostic Gaps
Even advanced tools like MRIs and biopsies have limitations. Early comparative studies found that:
- Random biopsies missed 20% of significant cancers.
- Older MRIs missed around 10%.
To address this, annual MRIs—similar to mammograms for women—can catch small lesions as they grow, often while still curable.
Why Not Use PSMA Scans Routinely?
While PSMA PET scans are more sensitive and could theoretically fill gaps left by MRIs, they come with radiation exposure and aren’t usually covered by insurance. MRI remains the preferred non-invasive imaging method.
Other Urine Tests: How Does MIPS2 Compare?
Tests like EPI, SelectMDx, and ExoDx function similarly to MIPS2, offering improved precision over PSA alone. MIPS2, however, has shown particularly strong performance in published data. All share the limitation that they provide probabilities, not certainties. This means they must be used carefully and interpreted in context.
Global Considerations and Accessibility
For international patients or those without access to a 3T MRI, urine tests like MIPS2 can serve as an alternative to random biopsy, helping avoid invasive procedures when the risk appears low. Understanding risk vs. benefit is key in these decisions.
Do Urine Tests Offer Information Beyond MRI?
Not really, says Dr. Scholz. While these tests offer risk stratification, they don’t visualize tumors like an MRI can. For some, probabilistic results are confusing—particularly when a “high-risk” label doesn’t guarantee cancer, and a “low-risk” result doesn’t eliminate it.
What If PSA Is Very High?
Urine tests are typically used when PSA is between 4 and 10. But if PSA rises above 10—especially with a normal-sized prostate—that alone is highly suggestive of cancer. In such cases, even a favorable MIPS2 might not be enough to dismiss the concern, and further imaging like an MRI is recommended.
What About Men With Normal PSA?
Even with normal PSA, clinically significant cancer can exist, especially in younger men. A PSA above 3.0 in younger individuals may already be cause for concern. In these cases, urine testing could offer early insights, but it’s not yet standard practice.
Navigating the Process Thoughtfully
Prostate cancer screening is a step-by-step process:
- Get a PSA test.
- Evaluate elevated results with tools like MIPS2 or MRI.
- Avoid rushing into treatment—especially with low-risk cancers.
There is a tendency in the U.S. toward aggressive treatment, even when it’s not necessary. Education and thoughtful decision-making are crucial.
Patient Education and Emotional Support
One of the biggest challenges patients face is interpreting test results. Terms like “high-risk” can cause anxiety and confusion. Dr. Scholz advises patients to:
- Ask what the test is before taking it.
- Understand what kind of data it provides.
- Bring questions to your doctor about what the results mean for your case.
This helps reduce anxiety and leads to informed decision-making.
Final Thoughts: You're Not Alone
Managing prostate cancer risk can be overwhelming. But you're not alone. Support is available:
- Visit PCRI.org for resources, conference info, and expert articles.
- Reach out to the PCRI Helpline—staffed by patients who’ve been through it themselves.
- Talk to your doctor with informed questions, and seek emotional support from loved ones or support groups.
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