Moosa Zulfiqar Ali  ( Medical College, Combined Military Hospital, Lahore, Pakistan )
Roshaan Ahmad  ( Medical College, Combined Military Hospital, Lahore, Pakistan )
Amna Akmal  ( Medical College, Combined Military Hospital, Lahore, Pakistan )

Prostate cancer is the second most often diagnosed cancer and the sixth most prevalent cause of cancer mortality in males globally.¹ It is usually screened by measuring prostate specific antigen (PSA) levels in the blood. However, the PSA test results in unnecessary biopsies, over-diagnosis, over-treatment, and higher expenses.² The Karolinska Institute in Stockholm, Sweden, developed the Stockholm³ test to overcome PSA test’s shortcomings.

Stockholm3 is a blood based test that examines PSA, plasma proteins, genetic markers, and clinical data (age, family history, previous biopsies).³ Eirik Viste et al.studied the outcome of substituting PSA with Stockholm3 for detecting clinically significant prostate cancer (csPC) (Gleason score ≥7). The results were significantly in favour of the Stockholm3 test. Data from 4784 subjects showed a 28% reduction in patients referred for further work-up, the percentage of biopsies positive for cspC increased from 42.1% (98/223) to 64.9% (185/285), and a decrease in direct health care costs by approximately 23-28%.⁴ A study published in the Lancet Oncology showed that with the help of the Stockholm3 test the amount of biopsies warranted fell by 32% and the number of benign biopsies by 42%.³ The superior efficiency of the Stockholm3 test showcases its ability to replace PSA in the early detection of prostate cancer in the primary healthcare setting.

Prostate cancer is a commonly diagnosed malignancy in Pakistan. Its prevalence is 6.7 per 100,000 in Pakistan.¹ Stockholm3 test can prove itself to become a vital tool in any country’s arsenal to combat the deadly prostate cancer, especially in developing and underdeveloped nations. There are no standardized and practical methods to universally screen individuals for prostate cancer in such countries. As a result, men often present late and become victims of poor prognoses. This relatively cheap alternative option can help physicians detect csPC early and improve patients’ outcomes. It can also improve patients’ compliance by decreasing the number of biopsies called for. In summary, Stockholm3 can become an extremely beneficial screening test in treating patients of prostate cancer.

Disclaimer: None.

Conflict of Interest: None.

Funding Sources: None.

References

1.       Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, etal. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer; 2020.

2.       Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, et al. Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT. Health Technol Assess. 2020;24:1.

3.       Grönberg H, Adolfsson J, Aly M, Nordström T, Wiklund P , Brandberg Y,et al. Prostate cancer screening in men aged 50-69 years (STHLM3): a prospective population-based diagnostic study. Lancet Oncol. 2015;16:1667-76.

4.       Viste E, Vinje CA, Lid TG, Svein S, Oystein EO, Nordstrom T, et al. Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cancer in a healthcare system – the Stavanger experience. Scand J Prim Health Care. 2020;38:315.