The Stockholm-3 (STHLM3) Model can Improve Prostate Cancer Diagnostics in Men Aged 50-69 yr Compared with Current Prostate Cancer Testing

Eur Urol Focus. 2018 Sep;4(5):707-710. doi: 10.1016/j.euf.2016.10.009. Epub 2016 Nov 23.


Prostate cancer screening is associated with low specificity, unnecessary biopsies, and overdiagnosis. We have previously shown that the Stockholm-3 model (S3M) can reduce biopsies compared with using prostate-specific antigen (PSA) ≥3ng/ml as an indication for biopsy. Urologists in today's current prostate cancer testing (CPT) have access to numerous variables in addition to PSA (eg, age, ethnicity, family history, free PSA, PSA velocity, digital rectal examination, and prostate volume) to support biopsy decisions. We estimated the number of prostate cancers diagnosed and prostate biopsies performed if S3M replaced CPT in Stockholm, Sweden, by comparing biopsy results in 56 282 men who underwent PSA testing according to CPT in Stockholm in 2011 with the 47 688 men enrolled in the STHLM3 validation cohort 2012-2015. With the same sensitivity as CPT to diagnose Gleason score ≥7 prostate cancer, S3M was estimated to reduce the number of men biopsied by 53% (95% confidence interval [CI]: 41-65%), avoid 76% (95% CI: 67-81%) of negative biopsies, and reduce Gleason score 6 cancers by 23% (95% CI: 6-40%). S3M has the potential to improve prostate cancer diagnostics by better selecting men with high risk of GS ≥7 prostate cancer. PATIENT SUMMARY: We modeled the effect the Stockholm-3 model would have on prostate cancer diagnostics if it replaced current clinical practice. We found that Stockholm-3 model may substantially reduce the number of biopsies, while maintaining the same sensitivity to diagnose clinically significant prostate cancer.

Keywords: Diagnostics; PSA; Prediction; Prostate cancer; S3M; STHLM3; Screening; Testing.

Publication types

  • Comparative Study
  • Letter
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biopsy / statistics & numerical data*
  • Clinical Decision-Making
  • Digital Rectal Examination / methods
  • Humans
  • Male
  • Mass Screening / methods*
  • Mass Screening / statistics & numerical data
  • Medical Overuse / prevention & control*
  • Medical Overuse / statistics & numerical data
  • Middle Aged
  • Neoplasm Grading / methods
  • Prostate / anatomy & histology
  • Prostate / pathology
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / pathology
  • Sweden / epidemiology


  • Prostate-Specific Antigen