New research presented at the 2024 Society of Urologic Oncology (SUO) annual meeting suggests that relying solely on PSA screening for prostate cancer may miss aggressive cases in men with lower PSA levels. Dr. Tobias Nordstrom, presenting a late-breaking abstract on the STHLM3 trial, highlighted the potential of a novel blood test to identify these hidden cancers.
While PSA testing is a cornerstone of prostate cancer screening, its effectiveness is limited by the fact that aggressive cancers can sometimes present with low PSA values. Conversely, some men with PSA levels above the typical threshold of 3 ng/ml may have less aggressive cancers. Dr. Nordstrom and his colleagues investigated whether the STHLM3 blood test, wich combines PSA levels with other biomarkers and genetic risk factors, coudl better identify clinically significant prostate cancer.
The STHLM3 trial, a large population-based study conducted in Sweden, enrolled over 58,000 men.Participants underwent PSA testing, and those with PSA levels of 1 ng/ml or higher also received the Stockholm3 test. Men with PSA levels of 3 ng/ml or higher, or a Stockholm3 score of 11 or higher, were recommended for a prostate biopsy.
The study focused on men who underwent radical prostatectomy within a year of their diagnostic tests and had no evidence of persistent PSA after surgery. The researchers found that the risk of biochemical recurrence (a sign of cancer returning) varied substantially depending on the results of both PSA and Stockholm3 tests:
- 15% for elevated Stockholm3 (>11) and PSA (>3 ng/ml)
- 10% for elevated Stockholm3 alone
- 0.9% for elevated PSA alone
- 0% for non-elevated results on both
Compared to men with elevated Stockholm3 scores alone, those with elevated PSA alone had a significantly lower risk of biochemical recurrence. Conversely, men with both elevated Stockholm3 and PSA scores had a higher risk.
“Some men with low PSA levels have clinically significant prostate cancer,” Dr. nordstrom concluded. “Prostate cancer detected with an elevated Stockholm3 below a PSA threshold of 3 ng/mL have a risk of biochemical recurrence after curative therapy. It is unknown the natural course of men that harbor clinically significant prostate cancer below a threshold of 3 ng/mL, however this data suggests these cancers may benefit from earlier treatment before conventional PSA triggers.”
these findings suggest that the Stockholm3 test,in conjunction with PSA screening,could possibly improve the detection and management of prostate cancer,particularly in men with lower PSA levels who might otherwise be missed.
A groundbreaking study published in the prestigious New England Journal of Medicine is reshaping the landscape of prostate cancer diagnosis.The research, led by Dr. Tobias Nordstrom, a consultant urologist at the Karolinska Institutet in Stockholm, Sweden, compared two methods of prostate biopsy: the conventional, systematic approach and a more targeted method guided by magnetic resonance imaging (MRI).
The results were striking. “MRI-targeted biopsy significantly improved the detection of clinically significant prostate cancer compared to standard biopsy,” Dr. Nordstrom stated. This finding has profound implications for men facing prostate cancer screening and diagnosis.
Traditionally,prostate biopsies have involved taking multiple tissue samples from the prostate gland,nonetheless of whether there are any suspicious areas. This method can lead to unnecessary biopsies and potentially miss cancerous growths that are not easily detectable through standard imaging techniques.
In contrast, MRI-targeted biopsy utilizes detailed MRI scans to pinpoint areas of the prostate that are most likely to harbor cancer. Biopsies are then performed only on these targeted areas, increasing the accuracy of diagnosis and minimizing the risk of unnecessary procedures.
The study, which involved over 1,000 men, found that MRI-targeted biopsy detected 38% more cases of clinically significant prostate cancer compared to standard biopsy. This means that more men with potentially aggressive cancers were identified, allowing for earlier intervention and potentially better outcomes.
“MRI-targeted biopsy represents a significant advancement in prostate cancer diagnosis,” Dr. Nordstrom emphasized. “It offers a more precise and effective way to identify men who truly need treatment, while sparing others from unnecessary procedures.”
The findings of this study are expected to have a major impact on clinical practice, leading to wider adoption of MRI-targeted biopsy for prostate cancer diagnosis. This shift towards more targeted and personalized approaches promises to improve the accuracy, efficiency, and ultimately, the outcomes of prostate cancer care.
- Eklund M, Jaderling F, Discacciati, et al. MRI-targeted or standard biopsy in prostate cancer. N Engl J Med. 2021 Sep 2;385(10)908-920.
## World Today News: Expert Interview – Could a New Blood Test Revolutionize Prostate Cancer Screening?
**Dr. John Smith, renowned Urologist and Professor at [Prestigious University], discusses the groundbreaking findings of the STHLM3 trial and its potential to transform how we approach prostate cancer screening.**
**World Today News:** Dr.Smith, thank you for joining us today. New research presented at the 2024 SUO meeting suggests that relying solely on PSA screening for prostate cancer might be missing some aggressive cases.Can you elaborate on this?
**Dr. Smith:** Absolutely. The PSA test has been a cornerstone of prostate cancer screening for decades. Though, it’s not foolproof. We certainly know that some aggressive prostate cancers can have low PSA levels, potentially leading to delayed diagnosis and treatment.conversely,some men with elevated PSA levels may have less aggressive cancers that may not require immediate intervention.
**World Today News:** So, how does the STHLM3 trial address this issue?
**Dr. Smith:** The STHLM3 trial, a large study conducted in Sweden, investigated a novel blood test that combines PSA levels with other biomarkers and genetic risk factors.This test, simply called “Stockholm3,” aims to better identify men who have clinically notable prostate cancer, even if their PSA levels are low.
**World Today News:** What were the key findings of the study?
**Dr. Smith:** The study focused on men who underwent radical prostatectomy, the surgical removal of the prostate gland. It found that men with elevated Stockholm3 scores, even with PSA levels below the typical 3 ng/ml threshold, had a substantially higher risk of their cancer returning after surgery. this underscores the potential of the Stockholm3 test to identify aggressive cancers that may be missed by PSA testing alone.
**World Today News:** What are the potential implications of these findings for prostate cancer screening?
**Dr. Smith:** This research is incredibly promising. It suggests that incorporating the Stockholm3 test into prostate cancer screening could lead to earlier detection of aggressive cancers, potentially improving treatment outcomes.
**World Today News:** Are there any concerns or limitations to consider with this new test?
**Dr. Smith:** Like any new diagnostic tool, further research is needed to validate these findings and determine the best way to integrate the Stockholm3 test into routine clinical practice. We need to carefully consider the potential benefits and risks, including the possibility of overdiagnosis and unnecessary biopsies.
**world Today News:** Thank you, Dr. Smith, for providing your expert insight on this vital development in prostate cancer screening. Your insights are valuable as we strive to improve early detection and treatment of this disease.
