# EarlyTect BCD Plus: A urine‐based dual site PENK methylation test for risk‐based cystoscopy triage in haematuria

## TL;DR

A new urine test called EarlyTect BCD Plus detects bladder cancer risk by measuring methylation in the PENK gene, potentially reducing the need for cystoscopy in some patients.

## Contribution

The study introduces a dual-site PENK methylation test with improved detection of Ta-LG bladder cancer and high negative predictive value.

## Key findings

- EarlyTect BCD Plus achieved 87.7% sensitivity and 97.0% NPV in detecting bladder cancer.
- Sensitivity for Ta-LG tumors improved to 60.5% compared to a single-marker assay.
- In intermediate-risk patients, the test showed 99.1% NPV for all bladder cancer and 100% for high-grade cases.

## Abstract

This study aims to develop and clinically evaluate EarlyTect BCD Plus, a urine‐based assay measuring two methylation sites of the PENK gene, and to assess its diagnostic performance and clinical utility according to haematuria risk stratification.

A dual‐target quantitative methylation‐specific PCR assay was optimized using the PENK gene and evaluated in 892 patients with haematuria from Korea and the United States who underwent cystoscopy and histopathology. Urine DNA was analysed for two PENK methylation markers, and test results were interpreted using a combined algorithm. Diagnostic accuracy was assessed, and clinical utility was further analysed for patients stratified by the 2025 AUA/SUFU haematuria guideline risk categories.

In the pooled cohort (gross haematuria, n = 509; microhaematuria, n = 366; unspecified haematuria, n = 17), EarlyTect BCD Plus achieved a sensitivity of 87.7% (95% CI, 81.5%–92.5%), specificity of 82.5% (95% CI, 79.6%–85.2%) and negative predictive value (NPV) of 97.0% (95% CI, 95.5%–98.0%). Sensitivity for Ta‐LG tumours improved to 60.5% compared with the original single‐marker assay, while high‐grade tumours were detected with 96.6% sensitivity. In the intermediate‐risk group, NPVs were 99.1% for all BC and 100% for high‐grade BC.

EarlyTect BCD Plus significantly enhances detection of Ta‐LG bladder cancer while maintaining high specificity. Its high NPV supports use as a non‐invasive adjunct and triage tool, allowing deferral of cystoscopy in selected haematuria patients.