From PSA to Stockholm3: Study Part 1 (PSA2STHLM3/1)

From PSA to Stockholm3, a Naturalistic Effectiveness Multipart Research Program: Study Part 1

This part of the project aims to analyze the effectiveness of the Stockholm3 test in regular clinical practice, both in general practice and in the specialist health care, as a tool for detecting patients who need further diagnostics for prostate cancer.

Study Overview

• Status: Active, not recruiting
• Conditions: Prostate Cancer
• Intervention / Treatment: Diagnostic test: PSA and Stockholm3

Detailed Description

Background:

Prostate cancer constitutes about 15 % of new cases of cancer among men globally, but about 27 % of all new cases of cancer in men in Norway. It is also the leading cause of cancer death among men, and nearly 1100 Norwegian men died from prostate cancer in 2014. However, only about 30 percent of new cases have an aggressive form of the disease. Therefore, the challenge is to detect and distinguish patients with aggressive disease from patients who have a low risk cancer.

The Prostate-Specific Antigen (PSA) is currently the main test used in primary care to detect and prioritize patients for further diagnostics. PSA is used for screening in many countries, but the Norwegian authorities consider the harms of using PSA for screening purposes (over-diagnosis and overtreatment) to outweigh the benefits (potentially reduced mortality). Nevertheless, it has been documented that a substantial amount of opportunistic PSA screening takes place in Norway.

At present, a novel test called the Stockholm3 test has been developed. A large prospective study has shown that the efficacy of the Stockholm3 test is superior to PSA, and both the sensitivity and the specificity are substantially higher for Stockholm3 than for PSA.

Aim The aim of this study is to analyze the effectiveness of the Stockholm3 test in regular clinical practice, including both primary care and specialized health care.

Study Design From September 2017, the urological department at Stavanger University Hospital requires a Stockholm3 answer in referrals of patients for further diagnostics of possible prostate cancer.

Comparable clinical data will be collected for a period before - and from a corresponding period after the Stockholm3 test was taken into use.

An analysis will then be carried out where the results from the period where referrals were based primarily on PSA will be compared with the results for the period in which the Stockholm 3 test was used.

Power calculation Based on results from the original Stockholm3 study and aggregated figures regarding PSA testing, prostate biopsies and MRI of the prostate in Stockholm and Stavanger, a statistical power has been calculated. Based on a two-sided alpha at 0.05 (i.e., 5%) and a 90% power the study need about 8000 participants to reliably answer the main study questions. An interim analysis will be conducted in the inclusion phase. A new power calculation will be performed based on the registered data, and the need of participants will be adjusted if necessary.

• Study Type: Observational
• Enrollment (Actual): 13431

Contacts and Locations

• Study Contact: Name: Svein R. Kjosavik, MD PhD; Phone Number: +47 90414252; Email: svein.kjosavik@sus.no
• Study Contact Backup: Name: Svein Skeie, MD PhD; Phone Number: +47 90748883; Email: svein.skeie@sus.no

Study Locations

• Norway
  • Stavanger, Norway
    • Stavanger University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

All men at risk of prostate cancer in the 18 municipalities covered by Stavanger University Hospital

Description

Inclusion Criteria:

• All men where a physicians in regular clinical work finds that there is an indication to take the test

Exclusion Criteria:

• known prostate cancer

Study Plan

How is the study designed?

Design Details

• Observational Models: Ecologic or Community
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of prostate cancer with Gleason score ≥ 7 / Gleason score ≤ 6	The percentage of patients whose prostate biopsies showed a Gleason score ≤ 6 or ≥7 among those referred for diagnostics based on a PSA test or a Stockholm3 test	9 to 12 months from september 2017 compared with a corresponding period one year earlier

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of prostate biopsies among patients tested with PSA and Stockholm3	The percentage of patients referred for further diagnosis of potential prostate cancer with biopsy among those who were tested with PSA over a period of time, compared to those tested with Stockholm3 for a corresponding period of time	9 to 12 months from september 2017 compared with a corresponding period one year earlier

Collaborators and Investigators

• Sponsor: Helse Stavanger HF
• Collaborators: Karolinska Institutet
• Investigators: Principal Investigator: Svein Kjosavik, MS PhD, Helse Stavanger HF

Publications and helpful links

General Publications

• Gronberg H, Adolfsson J, Aly M, Nordstrom T, Wiklund P, Brandberg Y, Thompson J, Wiklund F, Lindberg J, Clements M, Egevad L, Eklund M. Prostate cancer screening in men aged 50-69 years (STHLM3): a prospective population-based diagnostic study. Lancet Oncol. 2015 Dec;16(16):1667-76. doi: 10.1016/S1470-2045(15)00361-7. Epub 2015 Nov 10.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2017
• Primary Completion (Actual): December 31, 2021
• Study Completion (Anticipated): December 31, 2030

Study Registration Dates

• First Submitted: December 18, 2017
• First Submitted That Met QC Criteria: December 20, 2017
• First Posted (Actual): December 21, 2017

Study Record Updates

• Last Update Posted (Actual): April 24, 2023
• Last Update Submitted That Met QC Criteria: April 21, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: Diagnostics, over-diagnosis
• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Genital Neoplasms, Male; Prostatic Diseases; Prostatic Neoplasms
• Other Study ID Numbers: SUSID_637

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No