Prostate Biopsies Can Be Omitted in Most Patients with a Positive Stockholm3 Test and Negative Prostate Magnetic Resonance Imaging

Cathrine Alvær Vinje; Maria Nyre Vigmostad; Svein R Kjosavik; Henrik Grönberg; Bjørnar Gilje; Svein Skeie

doi:10.1016/j.euf.2023.08.009

Prostate Biopsies Can Be Omitted in Most Patients with a Positive Stockholm3 Test and Negative Prostate Magnetic Resonance Imaging

Eur Urol Focus. 2023 Oct 5:S2405-4569(23)00192-X. doi: 10.1016/j.euf.2023.08.009. Online ahead of print.

Authors

Cathrine Alvær Vinje¹, Maria Nyre Vigmostad², Svein R Kjosavik³, Henrik Grönberg⁴, Bjørnar Gilje⁵, Svein Skeie⁶

Affiliations

¹ Department of Urology, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
² Department of Oncology, Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. Electronic address: marvig@sus.no.
³ Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway.
⁴ Department of Surgery, Capio St. Göran's Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Oncology, Stavanger University Hospital, Stavanger, Norway.
⁶ Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Research, Stavanger University Hospital, Stavanger, Norway.

PMID: 37805292
DOI: 10.1016/j.euf.2023.08.009

Abstract

Background: Magnetic resonance imaging (MRI) combined with the Stockholm3 test can be used to inform biopsy decision-making in patients with a suspicion of prostate cancer.

Objective: To determine the consequence of omitting biopsies in men with a positive Stockholm3 test and a negative MRI.

Design, setting, and participants: In a real-life setting, 438 men with a positive Stockholm3 test and a negative MRI underwent systematic biopsies from 2017 to 2020.

Outcome measurements and statistical analysis: The Stockholm3 test result is a percentage risk score with or without a prostate volume cutoff. The main outcomes were the number of clinically significant (Gleason grade group [GG] ≥2) and nonsignificant (GG 1) prostate cancers.

Results and limitations: Median prostate-specific antigen was 4.5 ng/ml (interquartile range 2.8-6.4 ng/ml) and the median age was 69 yr. Systematic biopsies detected grade group (GG) ≥2 disease in 48 men (11%, 95% confidence interval [CI] 8.4-14.2%) and GG 1 disease in 94 men (21.5%, 95% CI 17.9-25.6%). Of 256 patients without a volume cutoff in the test report, GG ≥2 was detected in 37 men (14.5%, 95% CI 10.7-19.3%). Omitting biopsies in patients with a volume cutoff would miss 11 GG ≥2 cases (6%, 95% CI 3.4-10.5%), reduce the number of GG 1 cases detected by 37 (39.4%, 95% CI 30.1-49.5%), and avoid a total of 182 biopsies (41.6%, 95% CI 37.0-46.2%). Limitations include the lack of follow-up data.

Conclusions: Systematic biopsies can be omitted in patients with a positive Stockholm3 test and a negative MRI when there is a volume cutoff in the test report. With no volume cutoff, biopsies can be considered with shared decision-making.

Patient summary: When investigated on suspicion of prostate cancer with a positive Stockholm3 test and a negative MRI (magnetic resonance imaging), prostate biopsies are only necessary for a subgroup of patients. This can spare some men from undergoing biopsies and reduce the detection of clinically insignificant cancers.

Keywords: Biopsy; Biopsy naïve; Diagnosis; Magnetic resonance imaging; Previous negative biopsy; Prostate cancer; Stockholm3.