Is This Prostate Cancer Test Really 270% Better Than a PSA Test?

A video promoting a newer prostate cancer blood test recently drew more than one million views with a powerful headline: “This prostate cancer test is 270% better than a PSA test.”

Such a headline is designed to capture attention, and it certainly captured mine.

The test is called the EpiSwitch Prostate Cancer Detection Test, also known as the PSE test. It combines a patient’s PSA result with five epigenetic markers measured in the blood. The company reports 94% accuracy, 86% sensitivity, and 97% specificity. These figures appear impressive, particularly for individuals considering options following an elevated PSA.

However, it is important to consider whether the PSE test is truly 270% better than PSA, whether the approximately $900 cost is justified, and whether the test result will meaningfully influence subsequent clinical decisions.

The short answer is this: The EpiSwitch PSE test is a credible and interesting blood test with potential clinical value. The 2023 study produced promising results, particularly in reducing false-positive findings. But the study does not prove that PSE is 270% better than PSA in every meaningful sense.

PSE and PSA serve distinct purposes. The original study was limited in size and funded by the company that owns the technology. Additionally, PSE has not eliminated the necessity for careful, long-term monitoring.

The need for ongoing evaluation is particularly significant. Prostate cancer risk is not determined by a single event; rather, it requires assessment over an extended period.

What Is the EpiSwitch PSE Test?

The EpiSwitch PSE test is a blood-based laboratory-developed test intended to estimate a man’s current likelihood of having prostate cancer. It is ordered by a healthcare professional and performed with a standard blood draw.

The PSE test does not replace the prostate-specific antigen (PSA) test. Instead, it incorporates the PSA value into an algorithm alongside five chromosome conformation signatures. These signatures represent epigenetic patterns related to the three-dimensional folding of chromosomes.

The five markers utilized in the published model are associated with DAPK1, HSD3B2, SRD5A3, MMP1, and miRNA98.

The final report does not provide a numeric cancer score. Instead, it presents a binary result, indicating either a low likelihood or high likelihood of prostate cancer.

According to Oxford BioDynamics, a high-likelihood result corresponds to cancer confirmation in more than nine out of ten cases. Conversely, a low-likelihood result aligns with the absence of cancer in more than nine out of ten cases.

The report is intended to assist clinicians in determining whether to recommend additional diagnostic procedures, such as magnetic resonance imaging (MRI) or biopsy.

The company emphasizes that the PSE is a laboratory-developed test and has not been reviewed or cleared by the U.S. Food and Drug Administration. Therefore, a PSE result should not serve as the sole basis for patient care decisions.

What Did the 2023 EpiSwitch PSE Study Examine?

The primary accuracy data are derived from a 2023 study published in Cancers, in which researchers analyzed blood samples from 147 men across two distinct groups.

The first group comprised 109 men from the PROSTAGRAM screening pilot, aged 50 to 69 years, who participated in prostate cancer screening. Among these, 88 served as controls, and 21 were diagnosed with cancer. This cohort most closely approximated a screening population.

The second group consisted of 38 men from Imperial College NHS Trust, including nine cancer-negative controls and 29 individuals with established prostate cancer. The cancer cases encompassed organ-confined, locally advanced, and metastatic disease.

Researchers combined PSA values, treated as continuous variables, with five EpiSwitch markers. The model was trained on 46 samples and tested on 101 samples following random allocation and class balancing.

In the combined study population, the reported outcomes were as follows:

These findings represent strong preliminary results. Within this selected group, the PSE test generated fewer false positives and identified a higher proportion of cancers compared to PSA alone. However, the results were less pronounced when researchers analyzed only the 109 men from the PROSTAGRAM screening group.

Within this group, the PSE test demonstrated a positive predictive value of 66%, a negative predictive value of 95%, and an overall accuracy of 92%. The positive predictive value exhibited a wide confidence interval, ranging from approximately 30% to 90%, primarily due to the limited number of cancer cases in the study.

While these findings are encouraging, they do not demonstrate that the PSE test will achieve a 93% positive predictive value in a general screening population. Test performance frequently changes when transitioning from a small, selected study group to a larger population with lower cancer prevalence.

Where Does the “270% Better” Claim Come From?

The phrase “270% better than PSA” is not presented as a conclusion in the 2023 publication.

The study reports metrics such as accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. It does not assert that the PSE test is universally 270% superior to PSA.

Headlines referencing “percent better” frequently depend on the specific statistic selected and the method of comparison. Diagnostic odds ratios, relative improvements, changes in predictive value, and changes in overall accuracy are distinct metrics, each addressing a different aspect of test performance.

For example, if overall accuracy increases from a commonly cited figure of 55% for PSA to 94% for PSE, the PSE result is approximately 1.7 times higher than the PSA figure. This does not equate to a straightforward 270% increase in accuracy.

If the comparison is based on error reduction or an odds-based measure, a much larger percentage may result. Although the calculation may be technically accurate, such headlines often fail to convey the intended meaning to patients.

Many individuals interpret “270% better” to mean that the PSE test is more than three times as effective as PSA in all scenarios. However, the study does not substantiate this interpretation.

This is why I return to an old observation often attributed to Mark Twain: There are lies, damned lies, and statistics. The statistic itself might be real. The trouble begins when it is separated from the question it was designed to answer.

What Do PPV, NPV, Sensitivity, and Specificity Mean?

Diagnostic statistics can be complex; therefore, it is important to clarify their meanings.

Sensitivity asks: Among men who have cancer, how many receive a positive test result?

Specificity asks: Among men who do not have cancer, how many receive a negative result?

Positive predictive value, or PPV, asks: If the test is positive, what is the probability that cancer is present?

Negative predictive value, or NPV, asks: If the test is negative, what is the probability that cancer is absent?

PPV and NPV change with cancer prevalence. A test studied in a group containing many men with known advanced cancer will not necessarily produce the same predictive values in a general population where relatively few men have clinically significant prostate cancer.

The combined 2023 cohort had a cancer prevalence of approximately 34%. The authors acknowledged that a true population-screening cohort would have a much lower prevalence, around 3% to 4%.

They also wrote that performance in a screening setting would likely resemble the PROSTAGRAM subgroup more closely, where PSE’s positive predictive value was 66%, not 93%.

This distinction is seldom highlighted in widely circulated media coverage.

The Study Has Limitations You Should Know

The researchers identified several limitations:

• The total sample was small.
• The analysis was retrospective.
• There was no longitudinal follow-up because the samples were anonymized.
• The high-risk cohort had an unusually high prevalence of cancer.
• Gleason 6 and Gleason 7 cancers were both counted as positive diagnoses in the screening group.
• PSE was not compared directly with PHI or 4Kscore because those tests were not part of standard care in the United Kingdom.
• The model was developed and internally validated using samples from the two available cohorts rather than confirmed in a large, independent, prospectively enrolled population.

Consideration of funding sources and potential conflicts of interest is also warranted.

Oxford BioDynamics funded the study. Eight authors were company employees, one was a company director, and Oxford BioDynamics holds patents on the EpiSwitch technology.

Industry involvement does not inherently invalidate research. Companies frequently fund studies of their diagnostic products due to unique financial incentives. However, such involvement underscores the necessity for independent replication.

The study’s authors reached the same conclusion. They recommended larger, prospective, blinded validation in a low-prevalence screening population before broad adoption.

Has Newer Research Confirmed the PSE Test?

A 2025 real-world clinical utility study evaluated 187 patients who received PSE testing in a urology practice. Biopsy confirmation was available for 53 patients. The remaining 134 were analyzed through predictive modeling using PSE results and clinical variables.

The authors estimated that a low-likelihood PSE result could allow 66.4% to 79.1% of those patients to defer biopsy, depending on the model used. The assay had a 100% technical success rate and an average turnaround time of 4.4 days.

This study provides evidence suggesting that PSE may reduce the number of biopsies required in clinical practice.

It does not provide the same evidence as a prospective trial in which all participants undergo a defined reference standard and are followed over time. Only 53 of the 187 patients had biopsy confirmation. The biopsy-avoidance estimates for the remaining patients depended on predictive modeling.

The authors again called for prospective, multicenter studies with broader patient populations and longitudinal follow-up.

As of July 2026, PSE has accumulated additional real-world experience compared to the period when the original paper was published. However, a large, independent, prospective screening trial is still needed to evaluate the test's performance across diverse male populations and to determine whether PSE-guided decisions improve meaningful long-term outcomes.

What the EpiSwitch PSE Test Does Well

Skepticism regarding marketing claims should not lead to dismissal of the test itself. PSE demonstrates several strengths.

It is minimally invasive. It requires a blood draw rather than tissue sampling. It appears to improve specificity compared with a simple PSA cutoff, which could reduce false alarms.

It also provides another piece of information for men whose PSA, MRI, age, family history, prostate size, and clinical findings do not point in the same direction.

For individuals following a conventional diagnostic pathway, a low-likelihood PSE result may provide sufficient reassurance to defer further procedures such as MRI or biopsy, while a high-likelihood result could support the need for additional evaluation.

This represents a reasonable clinical application, which is considerably more limited than asserting that PSE is a new and superior replacement for PSA.

Why I Still Prefer PSA for Long-Term Monitoring

PSA is an imperfect test for detecting prostate cancer, as it was not originally intended to provide a definitive yes-or-no answer regarding the presence of cancer. PSA levels may increase due to benign prostate enlargement, inflammation, infection, ejaculation, urinary retention, recent instrumentation, or other factors. However, PSA offers a significant advantage: it is quantitative and can be easily repeated.

A PSA value of 5.8 may increase to 6.4, decrease to 5.1, or rise to 9.6. This measurement should be interpreted in conjunction with prostate volume, PSA density, free PSA, Prostate Health Index (PHI), symptoms, medication changes, illness, MRI findings, and previous trends. A single PSA result is often ambiguous, whereas a carefully interpreted series of results provides more meaningful information.

The PSE report provides either a high-likelihood or low-likelihood result, reflecting the patient's current status at the time of testing.

If a 52-year-old man receives a low-likelihood PSE result but his PSA remains elevated the following year, he encounters the same clinical dilemma. Should he repeat a test costing approximately $900 each year? What are the implications if the result shifts from low likelihood to high likelihood, and what subsequent actions should be taken?

Prostate cancer requires lifelong monitoring and cannot be managed by a single binary test. Therefore, I do not agree that PSE is inherently “better than PSA” without clearly defining the intended purpose. If the objective is to reduce false positives at a specific decision point, PSE may outperform a simple PSA cutoff. However, for affordable longitudinal monitoring, PSA remains more practical.

A more appropriate question is not, “Which test is superior?”

Instead, the relevant question is, “What decision am I attempting to make, and will this result influence that decision?”

Is the EpiSwitch PSE Test Worth the Cost?

Although private pricing varies, the PSE test is typically offered at approximately $900 or £905. In contrast, the PSA test is widely accessible and generally costs a small fraction of that amount.

For illustrative purposes, a $900 PSE test compared to a $10 PSA test represents an 8,900% increase in cost.

This statistic is as mathematically striking as the 270% headline and highlights the limitations of using percentages without appropriate context.

Cost alone does not determine value. For some men, avoiding an unnecessary biopsy, MRI, complication, or extended period of anxiety may justify the expense. For others, if the result does not alter the subsequent clinical decision, it simply adds cost without improving care.

Before ordering the test, it is important to consider: What actions will I take if the result indicates low likelihood, and what actions will I take if it indicates high likelihood?

If the answer is “nothing,” then the test offers minimal practical value.

Who Might Consider a PSE Test?

PSE might be useful for a man who:

• Has an elevated or rising PSA and wants more information before deciding on an MRI or biopsy.
• Has conflicting results, such as an elevated PSA with a negative or indeterminate MRI.
• Has undergone a prior negative biopsy but continues to have concerning PSA findings.
• Follows a conventional diagnostic pathway and would change his next decision based on a high- or low-likelihood result.
• Understands that PSE does not determine cancer grade, stage, location, or aggressiveness.

The PSE test is less useful when the result does not alter the management plan, when longitudinal monitoring is required after treatment, or when the primary concern is tracking changes in PSA over time.

My Bottom Line on EpiSwitch PSE Versus PSA

The EpiSwitch PSE test is supported by scientific evidence, and published results are promising. Its specificity and potential to reduce false-positive findings warrant further investigation.

The phrase “270% better than PSA” represents a marketing statement rather than a clinically substantiated conclusion. This claim simplifies complex statistical comparisons and overstates the evidence.

The original study enrolled 147 men, combining a screening cohort with individuals who had established and advanced cancer. The study relied on internal model validation and was funded by the technology’s owning company.

The 2025 clinical utility study contributed valuable real-world data; however, most participants did not undergo biopsy confirmation. The estimated reduction in biopsies was based on predictive modeling.

PSE may assist in determining the likelihood of cancer at a specific time point. PSA remains an inexpensive, quantitative, repeatable test that is valuable for monitoring changes over time. These tests serve complementary, not competing, roles.

Clinical decisions should not be based solely on impressive statistical claims.

Begin with a clear clinical question and a comprehensive review of the patient’s history. Consider PSA trends, prostate size, PSA density, free PSA or PHI when indicated, symptoms, medications, infections, and imaging findings. Assess whether PSE provides additional information that may influence clinical management.

The primary challenge often lies not with the PSA test itself, but with interpreting results and subsequent clinical decision-making.

Frequently Asked Questions (FAQ)

Is the EpiSwitch PSE test more accurate than PSA?

A 2023 study found that PSE demonstrated higher overall accuracy, sensitivity, specificity, and positive predictive value compared to PSA at a 3 ng/mL cutoff. However, because the study was small and internally validated, these findings require confirmation in larger, independent prospective trials.

Is PSE really 270% better than PSA?

The 2023 paper does not conclude that PSE is universally 270% better than PSA. This percentage varies depending on the specific statistical measure and calculation applied. It does not indicate that the test is more than three times as useful for every patient or clinical scenario.

What does a low-likelihood PSE result mean?

A low-likelihood result indicates that prostate cancer is less probable, but it does not eliminate the risk entirely. This result should be interpreted alongside PSA history and other relevant clinical findings.

What does a high-likelihood PSE result mean?

A high-likelihood result indicates an increased probability that prostate cancer is present. However, it does not provide information about the cancer’s location, grade, stage, or expected behavior.

Does the PSE test replace a PSA test?

No. PSE incorporates the patient’s PSA value within its algorithm and is intended to supplement, rather than replace, the PSA test.

Does PSE diagnose aggressive prostate cancer?

The current test estimates the probability that prostate cancer is present. It does not determine the tumor’s grade, stage, location, or aggressiveness.

Is the EpiSwitch PSE test FDA-approved?

No. The test is available in the United States as a laboratory-developed test conducted by a CLIA-certified high-complexity laboratory. It has not undergone review or clearance by the FDA.

How much does the EpiSwitch PSE test cost?

Pricing and insurance coverage may vary. Private pricing is typically reported at approximately $900 in the United States or £905 in the United Kingdom. Patients are advised to confirm the current price and insurance coverage prior to testing.

Should I repeat a PSE test every year?

No standardized long-term schedule has been established. This is one of the test’s practical limitations compared with an inexpensive numeric PSA that is routinely tracked over time.

About Dr. Stephen Petteruti

Dr. Stephen Petteruti is a board-certified physician, published researcher, medical educator, and author of Fight Cancer Like a Man. For more than 30 years, he has worked in preventive medicine, men’s health, healthy aging, and individualized medical decision-making. His prostate cancer work focuses on helping men understand risk, question automatic treatment pathways, protect quality of life, and make decisions based on the complete clinical picture rather than fear.

References

1. Pchejetski D, Hunter E, Dezfouli M, et al. Circulating chromosome conformation signatures significantly enhance PSA positive predicting value and overall accuracy for prostate cancer detection. Cancers (Basel). 2023;15(3):821. doi:10.3390/cancers15030821. https://www.mdpi.com/2072-6694/15/3/821
2. Berghausen J, Abdo J, Mathis R, Hunter E, Akoulitchev A, Pohlman GD. EpiSwitch PSE blood test reduces unnecessary prostate biopsies: a real-world clinical utility study. Cancers (Basel). 2025;17(13):2193. doi:10.3390/cancers17132193. https://pubmed.ncbi.nlm.nih.gov/40647492/
3. Alshaker H, Mills R, Hunter E, et al. Chromatin conformation changes in peripheral blood can detect prostate cancer and stratify disease risk groups. J Transl Med. 2021;19(1):74. doi:10.1186/s12967-021-02710-y. https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-02710-y
4. Eldred-Evans D, Burak P, Connor MJ, et al. Population-based prostate cancer screening with magnetic resonance imaging or ultrasonography: the IP1-PROSTAGRAM study. JAMA Oncol. 2021;7(3):395-402. doi:10.1001/jamaoncol.2020.7456. https://jamanetwork.com/journals/jamaoncology/fullarticle/2774986
5. Oxford BioDynamics. EpiSwitch Prostate Cancer Detection Test technical overview. Accessed July 31, 2026. https://assets.oxfordbiodynamics.com/PSE_Technical_Sheet.pdf
6. Oxford BioDynamics. EpiSwitch Prostate Cancer Detection Test. Accessed July 31, 2026. https://www.94percent.com/

Medical Information

This article provides general education and does not establish a physician-patient relationship. Test selection and interpretation should be based on individual history, examination, laboratory trends, and consultation with a qualified healthcare professional.