A Comparison of Stockholm3, Serum Biomarkers, and Risk Calculators to Predict Prostate Cancer in a Racially and Ethnically Diverse Cohort: Evaluation of the Stockholm3 Multiethnic SEPTA Trial.

IF 5.9 2区医学 Q1 UROLOGY & NEPHROLOGY

Journal of Urology Pub Date : 2025-05-01 Epub Date: 2025-04-09 DOI:10.1097/JU.0000000000004437

Alon Lazarovich, Hari Vigneswaran, Thorgerdur Palsdottir, Martin Eklund, Andrea Discacciati, Tobias Nordström, Rebecca A Hubbard, Nathan Perlis, Michael R Abern, Daniel M Moreira, Paul Yonover, Alexander K Chow, Kara Watts, Michael A Liss, Gregory R Thoreson, Andre L Abreu, Geoffrey A Sonn, Anna Plym, Fredrik Wiklund, Henrik Grönberg, Adam B Murphy, Scott Eggener

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引用次数: 0

Abstract

Purpose: The purpose of this study was to compare performance of Stockholm3 in an external validation with commonly used prostate cancer biomarkers and risk calculators.

Materials and methods: SEPTA was a multicenter trial validating Stockholm3 in a racially/ethnically diverse population of men meeting local care guidelines for prostate biopsy (2019-2023). In total, 2115 (98%) men with complete data for risk calculators and biomarkers were included. The primary outcome was detection of Grade Group ≥ 2 (GG ≥ 2) cancer. Predictors included Stockholm3, free/total PSA ratio, PSA density, European Randomized Study of Screening for Prostate Cancer-4, Prostate Biopsy Collaborative Group, and Prostate Cancer Prevention Trial version 2 risk calculators. Performance characteristics were computed at clinically used thresholds for each risk score. ROC analysis, graphical calibration assessment, and decision curve analysis were performed.

Results: Among 2115 men, median age was 63 years (IQR: 58-68), median PSA was 6.1 ng/mL (IQR: 4.5-9.0), 415 (20%) had a prior negative prostate biopsy, and 356 (17%) had an MRI performed before biopsy. There were 1200 (56.7%) benign biopsies performed, 307 (14.5%) GG1 cancers detected, and 608 (28.8%) GG ≥ 2 cancers detected. The Stockholm3 test had superior discrimination (all P < .001) compared with all evaluated biomarkers and risk calculators with an AUC of 0.82 vs 0.72 for free/total PSA, 0.76 for PSA density, 0.77 for European Randomized Study of Screening for Prostate Cancer-4, 0.74 for Prostate Biopsy Collaborative Group, and 0.78 for Prostate Cancer Prevention Trial version 2. Decision curve analysis demonstrated superior performance of Stockholm3, showing the highest positive net benefit. Compared with free/total PSA, Stockholm3 could reduce unnecessary biopsies by 44% while maintaining a 0.95 sensitivity.

Conclusions: Stockholm3 outperforms other commonly used biomarkers and risk calculators for detecting GG ≥ 2 cancer in a diverse population.

查看原文本刊更多论文

在一个种族和民族多样化的队列中，比较Stockholm3、血清生物标志物和风险计算器来预测前列腺癌：对Stockholm3多民族SEPTA试验的评价。

目的：本研究的目的是比较Stockholm3与常用的前列腺癌生物标志物和风险计算器在外部验证中的性能。材料和方法：SEPTA是一项多中心试验，在符合当地前列腺活检护理指南的不同种族/民族的男性人群中验证Stockholm3（2019-2023）。总共纳入了2115名（98%）具有完整风险计算器和生物标志物数据的男性。主要终点为≥2级组（GG≥2）癌的检测。预测因子包括Stockholm3、游离/总PSA比、PSA密度、欧洲前列腺癌筛查随机研究4、前列腺活检协作组和前列腺癌预防试验版本2风险计算器。以临床使用的阈值计算每个风险评分的表现特征。进行ROC分析、图形化校正评估及决策曲线分析。结果：在2115名男性中，中位年龄为63岁（IQR: 58-68），中位PSA为6.1 ng/mL (IQR: 4.5-9.0)， 415名（20%）既往有前列腺活检阴性，356名（17%）在活检前进行了MRI检查。行良性活检1200例（56.7%），检出GG1癌307例（14.5%），检出GG≥2癌608例（28.8%）。与所有评估的生物标志物和风险计算器相比，Stockholm3试验具有更好的辨别能力（均P < 0.001），游离/总PSA的AUC为0.82 vs 0.72， PSA密度为0.76，欧洲前列腺癌筛查随机研究4的AUC为0.77，前列腺活检协作组的AUC为0.74，前列腺癌预防试验版本2的AUC为0.78。决策曲线分析表明，Stockholm3具有优越的性能，显示出最高的正净效益。与游离/总PSA相比，Stockholm3可以减少44%的不必要活检，同时保持0.95的敏感性。结论：在不同人群中，Stockholm3在检测GG≥2癌症方面优于其他常用的生物标志物和风险计算器。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Urology 医学-泌尿学与肾脏学

CiteScore

11.50

自引率

7.60%

发文量

3746

审稿时长

2-3 weeks

期刊介绍： The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.