Study Compares Biomarkers and MRI to Improve Prostate Cancer Risk Prediction, Reduce Unnecessary Biopsies
New data from the Desai Sethi Urology Institute, presented at AUA2026, finds minimal differences between leading biomarkers and MRI when used together to predict clinically significant prostate cancer and guide biopsy decisions.
Desai Sethi Urology Institute (DSUI) researchers at the University of Miami Miller School of Medicine shared data at the world’s largest gathering of urologists that could help prevent unnecessary tests in men being evaluated for prostate cancer.
AUA2026 selected an abstract by Sanoj Punnen, M.D., DSUI vice chair of research, that compares commonly used biomarkers with each other and multi-parametric magnetic resonance imaging (MRI) prior to prostate biopsy in men being evaluated for prostate cancer.
Comparison of Biomarkers and MRI in Prostate Cancer Evaluation
Dr. Punnen and his team assessed the guideline-recommended 4Kscore® Test and ExoDx Prostate (IntelliScore) (EPI) exosome urine-based test, as well as MRI, for predicting prostate cancer grade in at-risk men. The work is derived from the National Cancer Institute-funded, single center Marker Driven Selection of Patients for Prostate Biopsy and Management (MDSelect) trial that Dr. Punnen leads.
Dr. Punnen presented the abstract, “A Comparison of MRI, 4Kscore and the EPI Test in a Prospective Clinical Trial of Men Undergoing Biopsy for Evaluation of Prostate Cancer: The MDSelect Trial,” at AUA2026, the American Urologic Association’s annual meeting.
“The goal is to predict which men are most likely to have clinically significant prostate cancer and benefit from a biopsy and simultaneously prevent having to do a biopsy in someone who has a low risk,” said Dr. Punnen, professor of urologic oncology at the Miller School and co-lead of the Cancer Control Research Program at Sylvester Comprehensive Cancer Center, part of the Miller School. “This is one of the biggest and first head-to-head National Institutes of Health-funded studies that prospectively compare two of the most commonly used commercial markers with MRI.”
4Kscore and EPI Tests Show Comparable Performance with MRI
DSUI researchers found the 4Kscore slightly outperformed the EPI test in its predictive value when used as a single test, although this comparison did not reach statistical significance. In combination with MRI, they saw little difference between the two.
“We did not detect significant differences in the number of avoided biopsies or missed grade 2 or higher prostate cancer, based on whether you started with an MRI or started with a biomarker,” Dr. Punnen said.
Advancing Precision in Prostate Cancer Screening and Diagnosis
As more advanced and noninvasive technologies to evaluate prostate cancer become available, it’s important that researchers study when these tests, procedures and technologies add value.
“MDSelect is just starting to yield answers that we will be publishing in peer-reviewed journals and presenting at meetings worldwide, which will help pave the way for more optimal evaluation of men being referred for suspicion of prostate cancer,” Dr. Punnen said.
More from Desai Sethi Urology Institute
Researchers are testing an AI-guided robotic ureteroscopy system designed to identify and begin laser treatment of kidney stones.
The SPIN study explores whether pelvic floor care can improve symptoms and quality of life for women with bladder cancer.
Two foundation grants support Miller School research into prostate cancer progression, treatment resistance and biomarkers and targets.
A Miller School clinical trial is testing testosterone therapy in men with low-risk prostate cancer who are undergoing active surveillance.
Tags: cancer research, Department of Urology, Desai Sethi Urology Institute, Dr. Sanoj Punnen, prostate cancer, Sylvester Comprehensive Cancer Center, urology