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Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cancer in a healthcare system - the Stavanger experience.

Authors
  • Viste, Eirik1, 2
  • Vinje, Cathrine Alvaer3, 4
  • Lid, Torgeir Gilje1, 2
  • Skeie, Svein4, 5
  • Evjen-Olsen, Øystein6
  • Nordström, Tobias7
  • Thorsen, Olav1, 2
  • Gilje, Bjørnar8
  • Janssen, Emiel A M9, 10
  • Kjosavik, Svein R1, 2
  • 1 Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. , (Norway)
  • 2 The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway. , (Norway)
  • 3 Department of Urology, Stavanger University Hospital, Stavanger, Norway. , (Norway)
  • 4 Department of Clinical Science, University of Bergen, Bergen, Norway. , (Norway)
  • 5 Department of Research, Stavanger University Hospital, Stavanger, Norway. , (Norway)
  • 6 Organization and Development Unit SUS 2023, Stavanger University Hospital, Stavanger, Norway. , (Norway)
  • 7 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. , (Sweden)
  • 8 Department of Oncology, Stavanger University Hospital, Stavanger, Norway. , (Norway)
  • 9 Department of Pathology, Stavanger University Hospital, Stavanger, Norway. , (Norway)
  • 10 Faculty of Science and Technology, University of Stavanger, Stavanger, Norway. , (Norway)
Type
Published Article
Journal
Scandinavian journal of primary health care
Publication Date
Sep 01, 2020
Volume
38
Issue
3
Pages
315–322
Identifiers
DOI: 10.1080/02813432.2020.1802139
PMID: 32772613
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care. Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3. Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital. GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer. Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of clinically significant prostate cancer (csPC) (Gleason Score ≥7) and clinically non-significant prostate cancer (cnsPC) (Gleason Score 6), in needle biopsies. Estimation of direct healthcare costs. Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Risk Score (p < 0.000001). The proportion of positive biopsies with csPC increased from 42% (98/233) before to 65% (185/285) after the implementation. Correspondingly, the proportion of cnsPC decreased from 58% (135/233) before to 35% (100/285) after the implementation (p < 0.0017). Direct healthcare costs were estimated to be reduced by 23-28% per tested man. Replacing PSA with Stockholm3 for early detection of prostate cancer in primary care is feasible. Implementation of Stockholm3 resulted in reduced number of referrals for needle-biopsy and a higher proportion of clinically significant prostate cancer findings in performed biopsies. Direct healthcare costs decreased. KEY POINTS A change from PSA to Stockholm3 for the diagnosis of prostate cancer in primary care in the Stavanger region in Norway is described and assessed. •Implementation of a new blood-based test for prostate cancer detection in primary care was feasible. A majority of GP clinics started to use the test within three months. •Implementation of the Stockholm3 test was followed by: -a 28% reduction in number of men referred for urological prostate cancer work-up -an increase in the proportion of clinically significant cancer in performed prostate biopsies from 42 to 65% -an estimated reduction in direct health care costs between 23 and 28%.

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