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Reducing MRI Use in Organized Prostate Cancer Testing Using Blood-based Biomarkers: The OPT Stockholm3 Study
Ugo Giovanni Falagario1, Shuang Hao2, Olof Akre3
1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Integrating the Stockholm3 blood test into organized prostate cancer testing (OPT) is feasible, significantly reducing magnetic resonance imaging (MRI) use and biopsies. This approach shows promise for optimizing prostate cancer screening pathways.
Area of Science:
- Urology
- Oncology
- Public Health
Background:
- Organized prostate cancer testing (OPT) programs aim to detect prostate cancer early.
- Magnetic resonance imaging (MRI) is a key diagnostic tool, but its use can be resource-intensive.
- The Stockholm3 test offers a potential method to refine screening protocols.
Purpose of the Study:
- To evaluate the feasibility of implementing the Stockholm3 test as a reflex assay within an organized prostate cancer testing program.
- To assess the impact of integrating Stockholm3 on magnetic resonance imaging (MRI) utilization.
- To analyze the cost implications and cancer detection rates associated with this integrated approach.
Main Methods:
- A pragmatic, population-based implementation study involving men aged 50-52 invited to organized prostate cancer testing (OPT).
- An experimental group (2024) used Stockholm3 if prostate-specific antigen (PSA) ≥2 ng/ml, with MRI if Stockholm3 ≥15%.
- A control group (2023) followed standard OPT (MRI if PSA ≥3 ng/ml). Outcomes included MRI use, biopsies, cancer detection (Grade Group 1 and ≥2), and cost thresholds.
Main Results:
- MRI use decreased by 64% in the Stockholm3 group compared to the standard OPT group (1.0% vs. 2.7%).
- Biopsy rates also decreased (0.4% vs. 0.6%).
- While cancer detection rates for Grade Group 1 and Grade Group ≥2 were lower in the Stockholm3 group, the study was underpowered to draw definitive conclusions on cancer detection efficacy.
Conclusions:
- Integrating Stockholm3 as a reflex test in OPT is feasible and leads to significant reductions in MRI scans and biopsies.
- Reflex testing at PSA ≥2 ng/ml and PSA ≥3 ng/ml thresholds shows potential for optimizing screening pathways.
- Further research is needed to fully assess the impact on cancer detection, as current findings are hypothesis-generating due to study limitations.
