Nordström Tobias, Engel Jan Chandra, Bergman Martin, Egevad Lars, Aly Markus, Eklund Martin, Palsdottir Thorgerdur, Grönberg Henrik
Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Eur Urol Open Sci. 2021 Jan 1;24:11-16. doi: 10.1016/j.euros.2020.12.004. eCollection 2021 Feb.
In men aged above 50 yr, lower urinary tract symptoms (LUTS), benign prostate hyperplasia, and prostate cancer are common urological conditions. Current guidelines for general practitioners frequently recommend prostate-specific antigen (PSA) testing in patients with LUTS for the detection of prostate cancer.
To assess the performance of PSA, PSA density, and the Stockholm3 blood test for identification of prostate cancer among men with LUTS.
In this post hoc analysis of a population-based diagnostic trial (STHLM3, = 58 588), 4588 men aged 50-69 yr, without previous prostate cancer, with International Prostate Symptom Score (IPSS) data, and having PSA ≥ 3 ng/mL were identified. Men with at least moderate LUTS, defined as an IPSS score of ≥8, were included. PSA density and Stockholm3 scores were calculated.
Participants underwent 10-12-core systematic prostate biopsies.
The primary outcome was significant prostate cancer (sPCa) defined as International Society of Urological Pathology (ISUP) grade ≥2. Logistic regression analysis adjusted for age and previous biopsy status was performed. The area under the receiver operating characteristic curve (AUC) was calculated, and decision curve analysis was performed.
Out of 4588 men, 1544 (34%) reported at least moderate LUTS. The median age was 64 yr, and 11% had undergone a previous prostate biopsy. The Stockholm3 test showed superior discrimination for sPCa to PSA density, which in turn showed superior discrimination to PSA (AUC 0.77 vs 0.70 vs 0.61, < 0.02). Calibration of the Stockholm3 test was adequate. Performing biopsy only in men with PSA ≥5 ng/mL saved 64% of biopsies, but resulted in missing 52% of detectable sPCa. Recommending biopsy for men with PSA density ≥0.07 resulted in sparing 26% of biopsy procedures and delaying the diagnosis of 12% of sPCa cases, with a 6.1% risk of sPCa among unbiopsied men. Recommending men with Stockholm3 ≥ 0.11 for biopsy resulted in sparing 53% of biopsy procedures and delaying the diagnosis of 20% of sPCa cases, with a 5.1% risk of finding sPCa in unbiopsied men.
PSA density and the Stockholm3 blood test were superior to PSA for the identification of prostate cancer among men with LUTS.
In this analysis of a large Swedish study, we find that the use of prostate-specific antigen (PSA) density or the Stockholm3 blood test instead of only PSA might improve the detection of prostate cancer among men with lower urinary tract symptoms.
在50岁以上男性中，下尿路症状（LUTS）、良性前列腺增生和前列腺癌是常见的泌尿系统疾病。全科医生的现行指南经常建议对LUTS患者进行前列腺特异性抗原（PSA）检测以筛查前列腺癌。
评估PSA、PSA密度和斯德哥尔摩3血液检测在LUTS男性中识别前列腺癌的性能。
设计、地点和参与者：在这项基于人群的诊断试验（STHLM3，n = 58588）的事后分析中，确定了4588名年龄在50 - 69岁、无前列腺癌病史、有国际前列腺症状评分（IPSS）数据且PSA≥3 ng/mL的男性。纳入至少有中度LUTS（定义为IPSS评分≥8）的男性。计算PSA密度和斯德哥尔摩3评分。
参与者接受10 - 12针系统前列腺穿刺活检。
主要结局是定义为国际泌尿病理学会（ISUP）分级≥2级的显著性前列腺癌（sPCa）。进行了年龄和既往活检状态校正的逻辑回归分析。计算受试者工作特征曲线（AUC）下面积，并进行决策曲线分析。
在4588名男性中，1544名（34%）报告至少有中度LUTS。中位年龄为64岁，11%的人曾接受过前列腺活检。斯德哥尔摩3检测对sPCa的鉴别能力优于PSA密度，而PSA密度又优于PSA（AUC分别为0.77、0.70和0.61，P < 0.02）。斯德哥尔摩3检测的校准是充分的。仅对PSA≥5 ng/mL的男性进行活检可节省64%的活检，但会漏诊52%的可检测sPCa。建议对PSA密度≥0.07的男性进行活检可节省26%的活检程序，但会延迟12%的sPCa病例的诊断，未活检男性中sPCa的风险为6.1%。建议对斯德哥尔摩3≥0.11的男性进行活检可节省53%的活检程序，但会延迟20%的sPCa病例的诊断，未活检男性中发现sPCa的风险为5.1%。
在LUTS男性中，PSA密度和斯德哥尔摩3血液检测在识别前列腺癌方面优于PSA。
在这项对一项大型瑞典研究的分析中，我们发现使用前列腺特异性抗原（PSA）密度或斯德哥尔摩3血液检测而非仅使用PSA可能会改善下尿路症状男性中前列腺癌的检测。
