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The Stockholm-3 (STHLM3) Model can Improve Prostate Cancer Diagnostics in Men Aged 50-69 yr Compared with Current
Martin Eklund1, Tobias Nordström1, Markus Aly2
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
European Urology Focus
|July 30, 2017
Summary
The Stockholm-3 model (S3M) can significantly reduce prostate cancer biopsies and negative biopsy rates. This improved prostate cancer screening method maintains high sensitivity for detecting clinically significant cancers, unlike current practices.
Area of Science:
- Urology
- Oncology
- Medical Diagnostics
Background:
- Prostate cancer screening often results in low specificity, leading to unnecessary biopsies and overdiagnosis.
- Current prostate cancer testing (CPT) utilizes various factors, including prostate-specific antigen (PSA), to guide biopsy decisions.
- The Stockholm-3 model (S3M) has previously demonstrated potential in reducing biopsies compared to PSA thresholds.
Purpose of the Study:
- To estimate the impact of replacing current prostate cancer testing (CPT) with the Stockholm-3 model (S3M) in Stockholm, Sweden.
- To compare the number of prostate cancer diagnoses and biopsies performed under S3M versus CPT.
- To evaluate S3M's ability to maintain diagnostic sensitivity for significant prostate cancers while reducing unnecessary procedures.
Main Methods:
- A comparative analysis was conducted using data from men who underwent PSA testing via CPT in Stockholm (2011) and the STHLM3 validation cohort (2012-2015).
- The study modeled the potential outcomes of implementing S3M across a large cohort of men.
- Statistical methods were used to estimate the reduction in biopsies and negative biopsy rates, maintaining sensitivity for Gleason score ≥7 prostate cancer.
Main Results:
- Implementing S3M was estimated to reduce the number of men biopsied by 53% (95% CI: 41-65%) compared to CPT.
- S3M could avoid 76% (95% CI: 67-81%) of negative biopsies.
- The model also projected a 23% reduction (95% CI: 6-40%) in the diagnosis of Gleason score 6 prostate cancers, while maintaining sensitivity for Gleason score ≥7 cancers.
Conclusions:
- The Stockholm-3 model (S3M) shows significant potential to enhance prostate cancer diagnostics.
- S3M can substantially decrease the number of prostate biopsies performed, thereby reducing associated costs and patient burden.
- By better selecting men at high risk for Gleason score ≥7 prostate cancer, S3M offers an improved approach to prostate cancer screening.
