We assessed the feasibility of implementation, reduction in magnetic resonance imaging (MRI) use, and cost implications of integrating Stockholm3 as a reflex blood test in organized prostate cancer testing (OPT).
This pragmatic, population-based implementation study included men aged 50-52 yr invited to OPT in 2023 (n = 17 801) and 2024 (n = 30 556) in Health Region Stockholm-Gotland. The experimental group (2024) had a Stockholm3 test if prostate-specific antigen (PSA) ≥2 ng/ml and an MRI if Stockholm3 ≥15%. The control group (2023) followed standard OPT (MRI if PSA ≥3 ng/ml). Outcomes were MRI use (primary), biopsies performed, detection of Grade Group (GG) 1 and GG ≥2 cancer, and Stockholm3 cost thresholds. Relative proportions (RPs) and decision-tree cost modeling were used.
MRI use decreased by 64%, from 2.7% (181/6663) in 2023 to 1.0% (70/7070) in 2024 (RP 0.36; 95% confidence intervals [CI], 0.28-0.48); biopsy rates decreased from 0.6% to 0.4% (RP 0.67; 95% CI, 0.41-1.07). Detection of GG 1 cancer decreased from 0.17% (11/6663) to 0.08% (6/7070) (RP 0.51; 95% CI, 0.19-1.39), and detection of GG ≥2 cancer decreased from 0.20% (13/6663) to 0.14% (10/7070) (RP 0.72; 95% CI, 0.32-1.65). A cost of €92 per Stockholm3 test would achieve cost neutrality. Limiting Stockholm3 testing to men with PSA ≥3 ng/ml would reduce MRI use and costs. Study limitations include the nonrandomized design, few cancer events, restricted age range, and short follow-up.
Integrating Stockholm3 as a reflex test in the first round of an OPT program is feasible. Reflex testing at PSA ≥2 ng/ml and PSA ≥3 ng/ml was associated with reductions in the numbers of MRI scans and biopsies performed. No cancers were detected at PSA 2.0-2.9 ng/ml; however, the study was underpowered to assess cancer detection, and this finding should be considered hypothesis-generating.
European urology oncology. 2026 Aug 07 [Epub ahead of print]
Ugo Giovanni Falagario, Shuang Hao, Olof Akre, Stefan Carlsson, Ahmad Abbadi, Markus Arvendell, Lottie Phillips, Fredrik Sundquist, Thomas Jiborn, Rebecka Arnsrud Godtman, Ola Bratt, Anna Lantz
Department 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. Electronic address: ., Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden., Department of Urology, Helsingborg Hospital, Helsingborg, Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.