Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cancer in a healthcare system – the Stavanger experience

Viste, Eirik; Vinje, Cathrine Alvær; Lid, Torgeir Gilje; Skeie, Svein; Olsen, Øystein Evjen; Nordström, Tobias; Thorsen, Olav; Gilje, Bjørnar; Janssen, Emiel A. M.; Kjosavik, Svein Reidar

doi:10.1080/02813432.2020.1802139

Cited by 26 publications

(19 citation statements)

References 20 publications

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“…Other factors than a FH of PCa, age and SNPs could be coupled together to create a predictive test for PCa diagnosis. Recently the Stockholm 3 test, which contains risk SNPs, plasma protein biomarkers and clinical variables, has shown promising results in risk stratifying patients for PCa in a screening setting and thereby avoiding unnecessary biopsies, while maintaining high sensitivity for clinically significant PCa [45–47].…”

Section: Discussionmentioning

confidence: 99%

Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study

et al. 2021

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To investigate whether a risk score for prostate cancer (PCa) lifetime risk can be used to optimise triaging of patients with a negative prostate biopsy, but under sustained suspicion of PCa. Patients and MethodsIn this prospective clinical study, we included, and risk scored patients who had a PCa-negative transrectal ultrasonography (TRUS)-guided prostate biopsy, but elevated prostate-specific antigen (PSA), a suspicious prostate digital rectal examination and/or a positive family history (FH) of PCa. The risk score estimated individual lifetime risk of PCa, based on a polygenic risk score (33 single nucleotide polymorphisms), age, and FH of PCa. Patients were followed, under urological supervision, for up to 4 years with annual controls, always including PSA measurements. Multiparametric magnetic resonance imaging (mpMRI) and/or prostate biopsy was performed at selected annual controls depending on risk score and at the urologist's/patient's discretion, which means that the follow-up differed based on the risk score. ResultsWe included 429 patients. After risk scoring, 376/429 (88%) patients were allocated to a normal-risk group (<30% PCa lifetime risk) and 53/429 (12%) to a high-risk group (≥30% PCa lifetime risk). The high-risk group had significantly different follow-up, with more biopsy and mpMRI sessions compared to the normal-risk group. PCa was detected in 89/429 (21%) patients, with 67/376 (18%) patients diagnosed in the normal-risk group and 22/53 (42%) in the high-risk group. There was no statistically significant difference in the cumulative incidence of PCa between the normal-risk group and the high-risk group after 4 years of follow-up. Currently, 67/429 (16%) patients are still being followed in this ongoing study. ConclusionIn a 4-year perspective, our PCa lifetime risk score did not demonstrate significant prognostic value for triaging patients, with a negative TRUS-guided biopsy and sustained suspicion of PCa.

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Section: Discussionmentioning

confidence: 99%

Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study

et al. 2021

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“…This management may also lead to a reduction in healthcare costs. It has been estimated that direct healthcare costs decreased by 23-28% per male studied [87].…”

Section: Stockholm3 Modelmentioning

confidence: 99%

Prostate Cancer Liquid Biopsy Biomarkers’ Clinical Utility in Diagnosis and Prognosis

Matuszczak

Schalken

Salagierski

2021

Cancers

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Prostate cancer (PCa) is the most common cancer in men worldwide. The current gold standard for diagnosing PCa relies on a transrectal ultrasound-guided systematic core needle biopsy indicated after detection changes in a digital rectal examination (DRE) and elevated prostate-specific antigen (PSA) level in the blood serum. PSA is a marker produced by prostate cells, not just cancer cells. Therefore, an elevated PSA level may be associated with other symptoms such as benign prostatic hyperplasia or inflammation of the prostate gland. Due to this marker’s low specificity, a common problem is overdiagnosis, which leads to unnecessary biopsies and overtreatment. This is associated with various treatment complications (such as bleeding or infection) and generates unnecessary costs. Therefore, there is no doubt that the improvement of the current procedure by applying effective, sensitive and specific markers is an urgent need. Several non-invasive, cost-effective, high-accuracy liquid biopsy diagnostic biomarkers such as Progensa PCA3, MyProstateScore ExoDx, SelectMDx, PHI, 4K, Stockholm3 and ConfirmMDx have been developed in recent years. This article compares current knowledge about them and their potential application in clinical practice.

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“…STHLM3 is a risk-based model for PC screening that combines 232 SNPs, a combination of plasma protein biomarkers (PSA, iPSA, fPSA, hK2, beta-microseminoprotein and macrophage inhibitory cytokine 1) and clinical variables (family history, age, prostate exam and previous biopsies) [ 153 ]. Studies have found that this model performed better than PSA alone for the detection of high-risk PC, exhibiting its potential to improve PC diagnosis by significantly reducing the number of unnecessary biopsies taken, while also preserving the same sensitivity to diagnose clinically significant PC [ 153 , 154 , 155 , 156 , 157 ].…”

Section: Techniques To Improve the Diagnostic Accuracy Of Pcmentioning

confidence: 99%

Tissue- and Liquid-Based Biomarkers in Prostate Cancer Precision Medicine

Meehan

Gray

Martínez-Pérez

et al. 2021

JPM

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Worldwide, prostate cancer (PC) is the second-most-frequently diagnosed male cancer and the fifth-most-common cause of all cancer-related deaths. Suspicion of PC in a patient is largely based upon clinical signs and the use of prostate-specific antigen (PSA) levels. Although PSA levels have been criticised for a lack of specificity, leading to PC over-diagnosis, it is still the most commonly used biomarker in PC management. Unfortunately, PC is extremely heterogeneous, and it can be difficult to stratify patients whose tumours are unlikely to progress from those that are aggressive and require treatment intensification. Although PC-specific biomarker research has previously focused on disease diagnosis, there is an unmet clinical need for novel prognostic, predictive and treatment response biomarkers that can be used to provide a precision medicine approach to PC management. In particular, the identification of biomarkers at the time of screening/diagnosis that can provide an indication of disease aggressiveness is perhaps the greatest current unmet clinical need in PC management. Largely through advances in genomic and proteomic techniques, exciting pre-clinical and clinical research is continuing to identify potential tissue, blood and urine-based PC-specific biomarkers that may in the future supplement or replace current standard practices. In this review, we describe how PC-specific biomarker research is progressing, including the evolution of PSA-based tests and those novel assays that have gained clinical approval. We also describe alternative diagnostic biomarkers to PSA, in addition to biomarkers that can predict PC aggressiveness and biomarkers that can predict response to certain therapies. We believe that novel biomarker research has the potential to make significant improvements to the clinical management of this disease in the near future.

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Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cancer in a healthcare system – the Stavanger experience

Cited by 26 publications

References 20 publications

Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study

Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study

Prostate Cancer Liquid Biopsy Biomarkers’ Clinical Utility in Diagnosis and Prognosis

Tissue- and Liquid-Based Biomarkers in Prostate Cancer Precision Medicine

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