A trip to England is likely to bring tourists to London landmarks such as Buckingham Palace, Westminster Cathedral, The Tower of London, Big Ben, and many more. Visitors galore hop on red double-decker tour buses for stops at such historic sites. However, if our staff at Sperling Prostate Center were to fly across “The Pond” for a few days in London, our first stop would be to visit University College London (UCL). There we could meet with esteemed colleagues in the field of prostate cancer (PCa) diagnosis and focal therapy. Though their names might not be familiar to our U.S. patients, the list of published British researchers and clinicians includes Mark Emberton, Caroline Moore, Veeru Kasivisvanathan, Hashim Ahmed and others who hail from that institution.

A Lead Radiologist in UCL’s division of Surgery & Interventional Science, Dr. Francesco Giganti, was recently quoted as saying, “The three-part multiparametric MRI [mpMRI] scan has been a game-changer for the diagnosis of prostate cancer, sparing thousands of patients unnecessary biopsies.” He ought to know. He and his fellow clinicians participated in UCL research studies demonstrating that mpMRI can distinguish the difference between suspicious areas that require biopsy from those that don’t, especially when performed on a powerful 3T magnet. Thus, mpMRI has been a true gift to patients.

Unfortunately, 3T mpMRI is still not available or geographically accessible for patients in many areas of the globe, including the U.S. Our own Center has a state-of-the-art 3T magnet, but many hospitals and community radiology centers are still equipped with less powerful 1.5T magnets. Their imaging results lack the same high resolution, so scan outcomes are often ambiguous. To be on the safe side, doctors will recommend biopsy to almost every patient who has an abnormal PSA and suspicious MRI. Many of these patients will go through a biopsy only to have it turn out negative for PCa.

An additional downside to having a less effective MRI is the cost in healthcare dollars. Whether the scan is covered by insurance or is an out-of-pocket expense to the patient, its lack of accuracy leads to the further cost of the biopsy which possibly wasn’t even needed. In a broad sense, this is a wasteful use of money, a patient’s time, and the unnecessary risk of biopsy side effects.

What to do if 3T mpMRI isn’t available

Thankfully, there’s a new alternative to 1.5T MRI that can help avoid unnecessary biopsy AND save medical dollars. It’s a simple, cost-effective blood test called the Stockholm3, and is used after an abnormal or suspicious PSA screening test when 3T mpMRI isn’t available. According to the manufacturer, this test “combines genetic-, protein- and clinical markers, [and] also provides a more accurate risk stratification for developing significant prostate cancer compared to PSA testing alone.

A 2024 paper published in the Journal of the American Medical Association (JAMA) reported the results of a large randomized clinical trial involving over 12,000 men with no previous PCa diagnosis. The authors described the study design as follows:

Participants underwent blood sampling for PSA and Stockholm3 tests to estimate their risk of clinically significant prostate cancer (Gleason score ≥3+4). After the blood tests were performed, participants were randomly assigned in a 2:3 ratio to receive a Stockholm3 test with systematic biopsy (biomarker group) or a PSA test followed by MRI with systematic and targeted biopsy (MRI-enhanced group). Data were analyzed from September 1 to November 5, 2023.^[i]

The research team demonstrated that in patients where the biomarker test results led to a systematic biopsy (conventional TRUS biopsy), significant PCa was diagnosed “at levels comparable with MRI-targeted biopsies based on PSA levels.” This is good news when state-of-the-art MRI and targeted biopsies are unavailable.

It’s good news, but not entirely perfect, because “the biomarker-based approach resulted in more biopsies and detected a greater number of indolent [insignificant] cancers” that may not have required biopsy. In any case, adding the Stockholm3 biomarker test into the detection/diagnosis pathway offers superior results—and possibly no need for a biopsy—for patients than the traditional PSA-to-biopsy road.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Björnebo L, Discacciati A, Falagario U, et al. Biomarker vs MRI-Enhanced Strategies for Prostate Cancer Screening: The STHLM3-MRI Randomized Clinical Trial. JAMA Netw Open. 2024;7(4):e247131.