Detectable prostate-specific antigen after radiotherapy for clinically localized prostate cancer.

Background: This study assesses the incidence and timing of undetectable prostate-specific antigen (PSA) after radiotherapy (RT) ± androgen deprivation therapy (ADT) and its association with prostate cancer mortality.

Methods: This is a population-based study including 5299 men undergoing RT (2006-2020) in the Stockholm County, Sweden with all their PSA tests until death or emigration. The authors calculated incidence and timing of undetectable PSA (PSA ≤0.

Epidemiology of High-risk Biochemical Recurrence After Primary Prostate Cancer Treatment.

Background And Objective: Biochemical recurrence (BCR) risk stratification guides treatment decisions after primary prostate cancer (PCa) treatment. We evaluated high-risk BCR (HR-BCR) definitions after radical prostatectomy (RP) or radiotherapy (RT) and their association with PCa-specific mortality (PCSM).

Methods: A population-based cohort study including 17 753 men treated with RP (n = 12 010) or RT (n = 5743) for localized PCa in Stockholm County between 2003 and 2021 was conducted.

Evaluating the performance of existing tools to predict clinically significant prostate cancer in men with indeterminate lesions on biparametric MRI and development of a novel multiplex model: a prospective cohort study.

Background: Indeterminate lesions on prostate MRI, such as PI-RADS 3, present a clinical challenge due to their equivocal nature, complicating biopsy decisions in men undergoing testing for prostate cancer. Understanding the predictive capacity of biomarkers and risk calculators is critical to improve clinical decision-making and reduce unnecessary biopsies.

Methods: In this prospective cohort study, men with PI-RADS 3 findings on biparametric MRI (bp-MRI) who underwent combined biopsy (fusion targeted and systematic) in the STHLM3-MRI randomised clinical trial (first- and second-rounds) and at Capio St Göran's Hospital (Capio PCC), Sweden were included, representing screening-by-invitation, repeat screening, and clinical practice cohorts, respectively.

A Comparison of Stockholm3, Serum Biomarkers, and Risk Calculators to Predict Prostate Cancer in a Racially and Ethnically Diverse Cohort: Evaluation of the Stockholm3 Multiethnic SEPTA Trial.

Purpose: The purpose of this study was to compare performance of Stockholm3 in an external validation with commonly used prostate cancer biomarkers and risk calculators.

Materials And Methods: SEPTA was a multicenter trial validating Stockholm3 in a racially/ethnically diverse population of men meeting local care guidelines for prostate biopsy (2019-2023). In total, 2115 (98%) men with complete data for risk calculators and biomarkers were included.

Cost Analysis of Prostate Cancer Care Using a Biomarker-enhanced Diagnostic Strategy with Stockholm3.

Background And Objective: Building on previous research demonstrating better prostate cancer (PC) diagnostics via a biomarker-enhanced approach, this study focuses on cost analysis of PC care using the Stockholm3 test. We assessed the economic impact in European health care systems using real-world evidence for diagnostic outcomes and relevant costs.

Methods: We evaluated two PC diagnostic strategies: (1) the conventional prostate-specific antigen (PSA) strategy with magnetic resonance imaging (MRI) and (2) PSA testing with a reflex to biomarkers at PSA ≥1.

Prostate cancer incidence and mortality in men exposed to α1-adrenergic receptor antagonists.

Background: α1-Adrenergic receptor antagonists are commonly used to treat benign prostatic hyperplasia. Preclinical studies suggest that they induce cell death and inhibit tumor growth. This study evaluated the risk of prostate cancer death in men using α1-adrenergic receptor antagonists.

The Capio Prostate Cancer Center Model for Prostate Cancer Diagnostics-Real-world Evidence from 2018 to 2022.

Background: The Capio Prostate Cancer Center (Capio PCC) in Stockholm, Sweden, adopts a comprehensive diagnostic approach, utilizing prostate-specific antigen (PSA), Stockholm3, and magnetic resonance imaging (MRI) for prostate cancer risk assessment, followed by targeted and systematic biopsies for high-risk cases.

Objective: This study aims to elucidate the clinical process and real-world outcomes of the Capio PCC model for prostate cancer diagnosis at Capio S:t Göran Hospital.

Design Setting And Participants: Between 2018 and 2022, a cohort of 12 406 men aged 45-75 yr underwent prostate cancer testing, adhering to Capio PCC's structured diagnostic protocol.

External Validation of the Rotterdam Prostate Cancer Risk Calculator and Comparison with Stockholm3 for Prostate Cancer Diagnosis in a Swedish Population-based Screening Cohort.

Background: The Rotterdam Prostate Cancer Risk Calculator (RPCRC) and Stockholm3 can be used to aid urologists in their decision to refer men to magnetic resonance imaging (MRI) or biopsy for early detection of prostate cancer.

Objective: To assess the external validity of the RPCRC and compare it with using PSA and Stockholm3 to detect clinically significant prostate cancer.

Design, Setting, And Participants: Using data from the prospective, population-based, randomised STHLM3-MRI screening trial, we included participants with prostate-specific antigen (PSA) ≥3 ng/ml or Stockholm3 risk threshold ≥11% in the standard group who underwent systematic prostate biopsies.

Digital Rectal Examination in Stockholm3 Biomarker-based Prostate Cancer Screening.

Background: Pathological digital rectal examination (DRE) is suggestive of prostate cancer but has low sensitivity and specificity. DRE is incorporated in many clinical risk calculators, but there is less evidence on how DRE performs in the setting of blood biomarkers and polygenic risk prediction models other than prostate-specific antigen (PSA) associated with prostate cancer. The Stockholm3 test combines a blood test and clinical variables including DRE.

External Validation of the Prostate Biopsy Collaborative Group Risk Calculator and the Rotterdam Prostate Cancer Risk Calculator in a Swedish Population-based Screening Cohort.

Background: External validation of risk calculators (RCs) is necessary to determine their clinical applicability beyond the setting in which these were developed.

Objective: To assess the performance of the Rotterdam Prostate Cancer RC (RPCRC) and the Prostate Biopsy Collaborative Group RC (PBCG-RC).

Design Setting And Participants: We used data from the prospective, population-based STHLM3 screening study, performed in 2012-2015.

Association of 5α-Reductase Inhibitors With Prostate Cancer Mortality.

Importance: There is evidence that 5α-reductase inhibitors (5-ARIs), a standard treatment of benign prostate hyperplasia, are associated with a decrease in the incidence of prostate cancer (PCa). However, studies to date have had conflicting results regarding the association with prostate cancer mortality (PCM).

Objective: To evaluate the association of treatment with 5-ARIs with PCM in men without a prior diagnosis of PCa.

A Head-to-head Comparison of Prostate Cancer Diagnostic Strategies Using the Stockholm3 Test, Magnetic Resonance Imaging, and Swedish National Guidelines: Results from a Prospective Population-based Screening Study.

Background: Strategies for early detection of prostate cancer aim to detect clinically significant prostate cancer (csPCa) and avoid detection of insignificant cancers and unnecessary biopsies. Swedish national guidelines (SNGs), years 2019 and 2020, involve prostate-specific antigen (PSA) testing, clinical variables, and magnetic resonance imaging (MRI). The Stockholm3 test and MRI have been suggested to improve selection of men for prostate biopsy.

Biomarker discrimination and calibration with MRI-targeted biopsies: an analysis with the Stockholm3 test.

Background: The validated Stockholm3 test is used to improve PC detection. Stockholm3, however, was developed using systematic biopsies. We aimed to assess Stockholm3 operating performance when using MRI-targeted biopsies for PC detection.

Lower urinary tract symptoms (LUTS) are not associated with an increased risk of prostate cancer in men 50-69 years with PSA ≥3 ng/ml.

There is conflicting evidence about the association between prostate cancer and Lower Urinary Tract Symptoms (LUTS). We aimed to describe the prevalence of LUTS and its association with prostate cancer risk. We studied the association between International Prostate Symptom Score (IPSS) and prostate cancer in a population-based sample of men ( = 45,595) aged 50-69 years from the Stockholm3 study.

A Unified Prostate Cancer Risk Prediction Model Combining the Stockholm3 Test and Magnetic Resonance Imaging.

Background: Risk prediction models and magnetic resonance imaging (MRI) of the prostate can reduce unnecessary biopsies and overdiagnosis of low-risk prostate cancer. However, it is unclear how these tools should be used in concert.

Objective: To develop a unified risk prediction model (S3M-MRI) that combines the Stockholm3 score (based on protein and genetic markers and clinical variables) and Prostate Imaging-Reporting and Data System v.

Are Prostate Specific-Antigen (PSA) and age associated with the risk of ISUP Grade 1 prostate cancer? Results from 72 996 individual biopsy cores in 6 083 men from the Stockholm3 study.

Background: Knowledge about the relationship between PSA, age and ISUP grade group (ISUP) 1 prostate cancer can improve clinical and biological understanding of prostate cancer. We aimed to investigate the associations between PSA and age and the risk of ISUP 1 and ISUP ≥ 2 prostate cancer, respectively.

Methods: We included 6 083 men aged 50-69 biopsied with a total of 72 996 individual biopsy cores from the prospective and population based Stockholm3 diagnostic study.

The impact of different prostate-specific antigen (PSA) testing intervals on Gleason score at diagnosis and the risk of experiencing false-positive biopsy recommendations: a population-based cohort study.

Objective: Given a man's current prostate- specific antigen (PSA) level, age and family history of prostate cancer, what are the benefits (decreased risk of higher Gleason score [GS] cancer at diagnosis) and harms (increased risk of false-positive biopsy recommendation) of waiting 1, 2, 3, 4 or 5-8 years until the next PSA test?

Design: Prospective cohort.

Setting: All PSA tested men in Stockholm, Sweden, between 2003 and 2015.

Participants: Men aged 50-74 years with at least two PSA tests between 2003 and 2015 (n=174 636).

E-Science technologies in a workflow for personalized medicine using cancer screening as a case study.

Objective: We provide an e-Science perspective on the workflow from risk factor discovery and classification of disease to evaluation of personalized intervention programs. As case studies, we use personalized prostate and breast cancer screenings.

Materials And Methods: We describe an e-Science initiative in Sweden, e-Science for Cancer Prevention and Control (eCPC), which supports biomarker discovery and offers decision support for personalized intervention strategies.