مقالات پذیرفته شده در هشتمین کنگره بین المللی زیست پزشکی
A Comprehensive Evaluation of Stockholm3 Test Implementation: Enhancing Prostate Cancer Detection While Reducing Unnecessary Biopsies"
A Comprehensive Evaluation of Stockholm3 Test Implementation: Enhancing Prostate Cancer Detection While Reducing Unnecessary Biopsies"
Amirhossein Bozorgian,1,*mohammadamir kakaee,2
1. Kermanshah Islamic Azad University - Faculty of Medical Sciences 2. Shahid Beheshti University of Medical Sciences
Introduction: Prostate cancer is the most common cancer in males and one in every eight males will receive a diagnosis over their lifetime. PSA is a conventional method for monitoring and treating prostate cancer that is utilized for early detection. The Stockholm3 blood test addresses issues like overtreatment and the need for more precise treatment by precisely estimating the risk of prostate cancer. The Karolinska Institute in Stockholm, Sweden created the Stockholm3 blood test, which estimates a man's chance of receiving a csPC during a prostate biopsy. In addition to 101 genetic markers, PSA, four more proteins, and clinical data including age, family history, and prior biopsies are also included.
Methods: Intervention
In September 2017, Stavanger University Hospital advised primary care physicians in the Stavanger region to use Stockholm3 to screen for prostate cancer in males as early as possible. Physicians were directed to send patients who had an elevated risk of csPS, as indicated by a Stockholm3 Risk Score of 11%. June 2017 saw the start of the Stockholm3 implementation, which included comprehensive instructions and the required lab equipment. Physicians were instructed to carry ahead with their diagnostic procedures, but for individuals who do not yet have prostate cancer, utilize Stockholm3. September 2017 was designated as the start date of the new practice, and after September 18th, hospital referrals based on PSA might be denied. In September 2017, Stavanger University Hospital advised primary care physicians in the Stavanger region to use Stockholm3 to screen for prostate cancer in males as early as possible. Physicians were directed to send patients who had an elevated risk of csPS, as indicated by a Stockholm3 Risk Score of 11%. June 2017 saw the start of the Stockholm3 implementation, which included comprehensive instructions and the required lab equipment. Physicians were instructed to carry ahead with their diagnostic procedures, but for individuals who do not yet have prostate cancer, utilize Stockholm3. September 2017 was designated as the start date of the new practice, and after September 18th, hospital referrals based on PSA might be denied.
Method
Monitoring the GPs' conversion rate from PSA to Stockholm3 was part of the deployment process. The research contrasted PSA readings with Stockholm3's needle-biopsy advice based on actual results from 4784 males who underwent testing between September 1, 2017, and October 12, 2018. Since the Stockholm3 test includes a threshold for a positive test that corresponds to the risk of a csPC at this level, the analysis employed a positive PSA test cutoff of 3ng/ml as an acceptable foundation for comparison.
Statistical analysis
Descriptive statistical techniques, such as percentages, proportions, and rates, were used to assess the data. Chi-square tests were used to examine variations in rates. P-values and confidence ranges for the results are displayed. By dividing the total number of positive biopsies by the number of csPC, the proportion of csPC was found. A simplified health economy cost-model was calculated using cost estimates from Stavanger University Hospital and outcome data from 4784 men tested with Stockholm3. Blood testing expenses were totaled and included blood sample, PSA, TRUS, MRI, Stockholm3, needle-biopsy, pathology workup, and sepsis after needle-biopsy. Re-biopsy rates of 30% and 60%, as well as post-biopsy sepsis rates of 2 and 5%, were used to calculate costs based on PSA. P-values less than 0.05 were regarded as statistically significant.
Results: Increased Detection of Clinically Significant Cancers: The incidence of aggressive tumors that are anticipated to respond well to therapy has been markedly increased by the Stockholm3 test.
Reduction in Unnecessary Biopsies: Because of the Stockholm3 test's increased specificity, fewer biopsies were conducted, which decreased the possibility of false positive results.
Improved Patient Management: Better risk categorization, more effective patient management, and better judgment when deciding between active treatment and monitoring were all experienced by the healthcare system.
Conclusion: While Stockholm 3 is considered a powerful tool in the diagnosis of prostate cancer, there are challenges and limitations. Among these challenges, we can mention the limited access to this test in some countries and the need for more research on its effectiveness in different population groups. In the space of three months, Stockholm3 effectively replaced PSA in primary care in the Stavanger region. In addition to lowering direct healthcare expenditures, the test boosted the percentage of prostate cancer that was clinically significant in biopsies and decreased the necessity for biopsies overall.