Martin Eklund1, Tobias Nordström1, Markus Aly2, Jan Adolfsson3, Peter Wiklund4, Yvonne Brandberg5, James Thompson6, Fredrik Wiklund1, Johan Lindberg1, Joseph C Presti7, Mark StLezin7, Mark Clements1, Lars Egevad5, Henrik Grönberg8. 1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital Solna, Stockholm, Sweden. 3. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital Solna, Stockholm, Sweden. 5. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. 6. Karolinska Institutet Biobank, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 7. Department of Urology, Kaiser Oakland Medical Center, Oakland, CA, USA. 8. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Electronic address: henrik.gronberg@ki.se.
Abstract
Prostate cancer screening is associated with low specificity, unnecessary biopsies, and overdiagnosis. We have previously shown that the Stockholm-3 model (S3M) can reduce biopsies compared with using prostate-specific antigen (PSA) ≥3ng/ml as an indication for biopsy. Urologists in today's current prostate cancer testing (CPT) have access to numerous variables in addition to PSA (eg, age, ethnicity, family history, free PSA, PSA velocity, digital rectal examination, and prostate volume) to support biopsy decisions. We estimated the number of prostate cancers diagnosed and prostate biopsies performed if S3M replaced CPT in Stockholm, Sweden, by comparing biopsy results in 56 282 men who underwent PSA testing according to CPT in Stockholm in 2011 with the 47 688 men enrolled in the STHLM3 validation cohort 2012-2015. With the same sensitivity as CPT to diagnose Gleason score ≥7 prostate cancer, S3M was estimated to reduce the number of men biopsied by 53% (95% confidence interval [CI]: 41-65%), avoid 76% (95% CI: 67-81%) of negative biopsies, and reduce Gleason score 6 cancers by 23% (95% CI: 6-40%). S3M has the potential to improve prostate cancer diagnostics by better selecting men with high risk of GS ≥7 prostate cancer. PATIENT SUMMARY: We modeled the effect the Stockholm-3 model would have on prostate cancer diagnostics if it replaced current clinical practice. We found that Stockholm-3 model may substantially reduce the number of biopsies, while maintaining the same sensitivity to diagnose clinically significant prostate cancer.
Prostate cancer screening is associated with low specificity, unnecessary biopsies, and overdiagnosis. We have previously shown that the Stockholm-3 model (S3M) can reduce biopsies compared with using prostate-specific antigen (PSA) ≥3ng/ml as an indication for biopsy. Urologists in today's current prostate cancer testing (CPT) have access to numerous variables in addition to PSA (eg, age, ethnicity, family history, free PSA, PSA velocity, digital rectal examination, and prostate volume) to support biopsy decisions. We estimated the number of prostate cancers diagnosed and prostate biopsies performed if S3M replaced CPT in Stockholm, Sweden, by comparing biopsy results in 56 282 men who underwent PSA testing according to CPT in Stockholm in 2011 with the 47 688 men enrolled in the STHLM3 validation cohort 2012-2015. With the same sensitivity as CPT to diagnose Gleason score ≥7 prostate cancer, S3M was estimated to reduce the number of men biopsied by 53% (95% confidence interval [CI]: 41-65%), avoid 76% (95% CI: 67-81%) of negative biopsies, and reduce Gleason score 6 cancers by 23% (95% CI: 6-40%). S3M has the potential to improve prostate cancer diagnostics by better selecting men with high risk of GS ≥7 prostate cancer. PATIENT SUMMARY: We modeled the effect the Stockholm-3 model would have on prostate cancer diagnostics if it replaced current clinical practice. We found that Stockholm-3 model may substantially reduce the number of biopsies, while maintaining the same sensitivity to diagnose clinically significant prostate cancer.
Authors: Shea P Connell; Robert Mills; Hardev Pandha; Richard Morgan; Colin S Cooper; Jeremy Clark; Daniel S Brewer Journal: Cancers (Basel) Date: 2021-04-27 Impact factor: 6.639
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Authors: Elizabeth C Page; Elizabeth K Bancroft; Mark N Brook; Melissa Assel; Mona Hassan Al Battat; Sarah Thomas; Natalie Taylor; Anthony Chamberlain; Jennifer Pope; Holly Ni Raghallaigh; D Gareth Evans; Jeanette Rothwell; Lovise Maehle; Eli Marie Grindedal; Paul James; Lyon Mascarenhas; Joanne McKinley; Lucy Side; Tessy Thomas; Christi van Asperen; Hans Vasen; Lambertus A Kiemeney; Janneke Ringelberg; Thomas Dyrsø Jensen; Palle J S Osther; Brian T Helfand; Elena Genova; Rogier A Oldenburg; Cezary Cybulski; Dominika Wokolorczyk; Kai-Ren Ong; Camilla Huber; Jimmy Lam; Louise Taylor; Monica Salinas; Lidia Feliubadaló; Jan C Oosterwijk; Wendy van Zelst-Stams; Jackie Cook; Derek J Rosario; Susan Domchek; Jacquelyn Powers; Saundra Buys; Karen O'Toole; Margreet G E M Ausems; Rita K Schmutzler; Kerstin Rhiem; Louise Izatt; Vishakha Tripathi; Manuel R Teixeira; Marta Cardoso; William D Foulkes; Armen Aprikian; Heleen van Randeraad; Rosemarie Davidson; Mark Longmuir; Mariëlle W G Ruijs; Apollonia T J M Helderman van den Enden; Muriel Adank; Rachel Williams; Lesley Andrews; Declan G Murphy; Dorothy Halliday; Lisa Walker; Annelie Liljegren; Stefan Carlsson; Ashraf Azzabi; Irene Jobson; Catherine Morton; Kylie Shackleton; Katie Snape; Helen Hanson; Marion Harris; Marc Tischkowitz; Amy Taylor; Judy Kirk; Rachel Susman; Rakefet Chen-Shtoyerman; Allan Spigelman; Nicholas Pachter; Munaza Ahmed; Teresa Ramon Y Cajal; Janez Zgajnar; Carole Brewer; Neus Gadea; Angela F Brady; Theo van Os; David Gallagher; Oskar Johannsson; Alan Donaldson; Julian Barwell; Nicola Nicolai; Eitan Friedman; Elias Obeid; Lynn Greenhalgh; Vedang Murthy; Lucia Copakova; Sibel Saya; John McGrath; Peter Cooke; Karina Rønlund; Kate Richardson; Alex Henderson; Soo H Teo; Banu Arun; Karin Kast; Alexander Dias; Neil K Aaronson; Audrey Ardern-Jones; Chris H Bangma; Elena Castro; David Dearnaley; Diana M Eccles; Karen Tricker; Jorunn Eyfjord; Alison Falconer; Christopher Foster; Henrik Gronberg; Freddie C Hamdy; Vigdis Stefansdottir; Vincent Khoo; Geoffrey J Lindeman; Jan Lubinski; Karol Axcrona; Christos Mikropoulos; Anita Mitra; Clare Moynihan; Gadi Rennert; Mohnish Suri; Penny Wilson; Tim Dudderidge; Judith Offman; Zsofia Kote-Jarai; Andrew Vickers; Hans Lilja; Rosalind A Eeles Journal: Eur Urol Date: 2019-09-16 Impact factor: 20.096
Authors: Ola Spjuth; Andreas Karlsson; Mark Clements; Keith Humphreys; Emma Ivansson; Jim Dowling; Martin Eklund; Alexandra Jauhiainen; Kamila Czene; Henrik Grönberg; Pär Sparén; Fredrik Wiklund; Abbas Cheddad; Þorgerður Pálsdóttir; Mattias Rantalainen; Linda Abrahamsson; Erwin Laure; Jan-Eric Litton; Juni Palmgren Journal: J Am Med Inform Assoc Date: 2017-09-01 Impact factor: 4.497