Discacciati Andrea, Abbadi Ahmad, Clements Mark S, Annerstedt Magnus, Carlsson Stefan, Grönberg Henrik, Jäderling Fredrik, Eklund Martin, Nordström Tobias
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
C-Medical Urology Odenplan, Stockholm, Sweden.
Eur Urol Oncol. 2024 Nov 18. doi: 10.1016/j.euo.2024.10.016.
The use of blood-based risk prediction tools has been proposed to improve prostate cancer screening, but data on repeated screening are lacking. Our aim was to compare outcomes using the blood tests prostate-specific antigen (PSA) and Stockholm3 for repeat prostate cancer screening.
In the population-based screening-by-invitation STHLM3-MRI trial, men aged 50-74 yr were invited to participate in screening. At 2-3 yr after the initial round, men with PSA ≥1.5 ng/ml at trial inclusion who were randomized to magnetic resonance imaging (MRI)-enhanced screening and were not diagnosed with prostate cancer after the initial round were invited for repeat screening involving analysis of PSA and Stockholm3. Biparametric 1.5-T MRI was performed in cases with PSA ≥3 ng/ml or Stockholm3 ≥0.11. Men with Prostate Imaging0Reporting and Data System ≥3 lesions were referred for targeted plus systematic biopsies. The primary outcome was Gleason ≥7 cancer. Secondary outcomes included the number of MRI scans and biopsy procedures, and detection of Gleason 6 and Gleason ≥4 + 3 cancer. Outcomes were compared using the relative positive fractions (RPF).
Of 7609 men from the initial screening round, 2078 were eligible for repeat screening and 1500 (72%) participated. For detection of Gleason ≥7 prostate cancer, the area under the receiver operating characteristic curve was 0.765 (95% confidence interval [CI] 0.725-0.805) for Stockholm3 and 0.651 (95% CI 0.601-0.701) for PSA. Stockholm3 ≥0.15 was associated with 41% fewer MRI scans in comparison to PSA ≥3 ng/ml (RPF 0.59, 95%CI 0.54-0.64), while the detection of GS ≥4 + 3 cancers was similar (RPF 1.00, 95% CI 0.78-1.29). Stockholm3 ≥0.15 detected fewer Gleason ≥7 (RPF 0.75, 95% CI 0.59-0.95) and Gleason 6 (RPF 0.73, 95% CI 0.46-1.16) cancers. Stockholm3 ≥0.11 was associated with no decrease in the number of MRI scans, but an increase of the number of cancer cases detected. Limitations include the lack of long-term outcomes.
Use of the Stockholm3 test for repeated prostate cancer screening could reduce the need for MRI while maintaining detection rates for high-risk cancer.
In this study, we invited men to a second round of prostate cancer screening. We found that use of a new blood test called Stockholm3 can make screening programs more efficient by using fewer resources while still detecting aggressive cancers.
有人提议使用基于血液的风险预测工具来改进前列腺癌筛查，但缺乏关于重复筛查的数据。我们的目的是比较使用血液检测前列腺特异性抗原（PSA）和斯德哥尔摩3（Stockholm3）进行重复前列腺癌筛查的结果。
在基于人群的受邀筛查STHLM3-MRI试验中，邀请50至74岁的男性参与筛查。在首轮筛查后2至3年，首轮纳入时PSA≥1.5 ng/ml、被随机分配至磁共振成像（MRI）强化筛查且首轮未被诊断为前列腺癌的男性受邀进行重复筛查，包括PSA和Stockholm3分析。PSA≥3 ng/ml或Stockholm3≥0.11的病例进行双参数1.5-T MRI检查。前列腺影像报告和数据系统（PI-RADS）≥3级病变的男性被转诊进行靶向加系统活检。主要结局是Gleason≥7级癌症。次要结局包括MRI扫描次数和活检程序数量，以及Gleason 6级和Gleason≥4+3级癌症的检测情况。使用相对阳性率（RPF）比较结局。
首轮筛查的7609名男性中，2078名符合重复筛查条件，1500名（72%）参与。对于检测Gleason≥7级前列腺癌，Stockholm3的受试者工作特征曲线下面积为0.765（95%置信区间[CI] 0.725-0.805），PSA为0.651（95%CI 0.601-0.701）。与PSA≥3 ng/ml相比，Stockholm3≥0.15与MRI扫描次数减少41%相关（RPF 0.59，95%CI 0.54-0.64），而GS≥4+3级癌症的检测情况相似（RPF 1.00，95%CI 0.78-1.29）。Stockholm3≥0.15检测到的Gleason≥7级（RPF 0.75，95%CI 0.59-0.95）和Gleason 6级（RPF 0.73，95%CI 0.46-1.16）癌症较少。Stockholm3≥0.11与MRI扫描次数未减少相关，但检测到的癌症病例数增加。局限性包括缺乏长期结局数据。
使用Stockholm3检测进行重复前列腺癌筛查可减少对MRI的需求，同时维持高危癌症的检测率。
在本研究中，我们邀请男性进行第二轮前列腺癌筛查。我们发现，使用一种名为Stockholm3的新血液检测可通过使用更少资源使筛查项目更高效，同时仍能检测出侵袭性癌症。
