The Stockholm-3 Model for Prostate Cancer Detection: Algorithm Update, Biomarker Contribution, and Reflex Test...

Area of Science:

• Oncology
• Biomarker Discovery
• Diagnostic Accuracy

Background:

• Prostate-specific antigen (PSA) is a common but imperfect screening tool for prostate cancer.
• The Stockholm-3 model (S3M) has demonstrated superior performance compared to PSA alone.
• There is a need to refine S3M and assess its utility as a secondary screening test.

Purpose of the Study:

• To update the Stockholm-3 model (S3M) with new predictors.
• To quantify the contribution of each predictor within the S3M.
• To evaluate S3M's effectiveness as a reflex test for men with PSA levels ≥3 ng/ml.

Main Methods:

• The Stockholm-3 study (2012-2015) involved 59,159 men aged 50-69.
• Logistic regression updated S3M, incorporating HOXB13 and excluding intact PSA.
• Performance was compared by assessing the number of biopsies required to achieve equal sensitivity for high-grade cancer detection.

Main Results:

• The updated S3M showed a slight improvement in the area under the receiver operating characteristic curve (0.75 vs. 0.74).
• As a reflex test for men with PSA ≥3 ng/ml, S3M reduced the number of biopsies by 34% compared to PSA alone, maintaining equal sensitivity.
• A limitation noted was the ethnically homogeneous study population.

Conclusions:

• The Stockholm-3 model (S3M) effectively mitigates the issue of excessive unnecessary biopsies in PSA screening.
• Utilizing S3M as a reflex test offers a more efficient diagnostic pathway for prostate cancer.
• This approach aids in identifying aggressive prostate cancer while reducing the number of negative biopsies.