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Stockholm3 study awarded best abstract in the prostate cancer biopsy indication session at the 2024 European Association of Urology meeting

The annual 2024 European Association of Urology (EAU) meeting was held in Paris from April 5 – 8. More sophisticated risk adapted prostate cancer strategies was a focus area, including six abstracts evaluating Stockholm3 in populations across Europe and North America. An abstract utilizing a baseline Stockholm3 score to predict biochemical recurrence after prostatectomy was awarded best abstract in the prostate cancer biopsy indication session.

The awarded abstract evaluated cancers missed when using PSA cutoffs of 3 ng/ml, compared to Stockholm3 of ≥11 (1). The cohort consisted of men who participated in the original STHLM3 trial and underwent radical prostatectomy with curative intent. The STHLM3 study was a paired design trial, where men with elevated PSA (≥3 ng/ml) and a Stockholm3 ≥11 underwent biopsy.

The follow-up study evaluated the 5-year biochemical recurrence for these men. The results showed that less than 1% (1/115) of the cancers missed by Stockholm3 had biochemical recurrence at a 5-year follow-up, compared to 11% (9/82) of the cancers missed by PSA ≥3. The cancers missed by PSA were identified by Stockholm3, followed by biopsy, and the diagnosed men underwent prostatectomy.

The results of this follow-up study suggest the following:

  • Stockholm3 identifies aggressive cancer that traditional, interval PSA screening misses and thus may better identify men within the window of cure.
  • Stockholm3 can predict men that may develop biochemical recurrence after prostatectomy.
  • Cancers missed by Stockholm3 behave less aggressively than cancers missed by PSA.

These results build off abstract results presented at EAU 2023, Micoli et al. (2), showing a trend toward reduced prostate cancer specific mortality from the same STHLM3 trial.

“Large screening trials have shown that PSA testing reduces prostate cancer specific mortality, but PSA testing alone doesn’t eliminate it. These results suggest that by using an adjunct Stockholm3 test at lower PSA thresholds, clinically relevant and potentially lethal cancers can be detected and cured. This data also suggests there is additional prognostic benefit of baseline Stockholm3 testing” says Dr. Hari Vigneswaran, Karolinska Institutet researcher, urologist and Director of Medical Affairs at A3P Biomedical.

Other Stockholm3 presentations at the EAU covered a wide range of topics, including:
Organized prostate testing and screening, multi-ethnic validation, clinical use in men ≥75 years, compliance of Stockholm3 vs. PSA, and cost-effectiveness in a diagnostic and treatment care pathway.

(1) Vigneswaran HT; Palsdottir T; Grönberg H; Nordström T; Egevad L; Eklund M. “Stockholm3 to predict post-operative risk and biochemical recurrence after radical prostatectomy: Evidence from the STHLM3 trial” EUROPEAN UROLOGY. 2024;85:s1674-s1675

(2) Micoli C; Crippa A; Discacciati A; Vigneswaran H; Palsdottir T; Clements M; Aly M; Adolfsson J; Fredrik W; Wiklund P; James T; Lindberg J; Gronberg H; Egevad L; Nordstrom T; Eklund M. “The Stockholm3 prostate cancer screening trial (STHLM3): An interim analysis of mortality results after 6.5 years of follow-up.” EUROPEAN UROLOGY. 2023;83:s1266-s1267