Abstract
WHO reminds us that screening starts with a “rough sorting process”, to identify those individuals at increased risk of the target condition, followed by a diagnostic test to ascertain whether the condition is present.1 In The Lancet Oncology, Tobias Nordström and colleagues2 are to be congratulated on their prostate cancer screening study (STHLM3-MRI), which uses a two-step paired and randomised design to test the performance of novel blood-based diagnostic tests and MRI with subsequent targeted plus systematic prostate biopsies compared with traditional approaches for prostate cancer screening.
Highlights
The WHO reminds us that screening starts with a ‘rough sorting process’, to identify those at higher risk of the target condition, followed by a diagnostic test, to determine whether the condition is present[1]
The European Randomised Screening for Prostate Cancer (ERSPC) used digital rectal examination and the prostate specific antigen (PSA) blood test as the ‘sorting’ tests for men deemed at risk due to age, with standard transrectal biopsy as the diagnostic test for men who tested positive either on DRE or with a PSA of > 3ng/ml
Nordstrom and colleagues have used a more complex initial first test, the Stockholm 3 risk calculator (STHLM3), which incorporates age, previous biopsy history, PSA derivatives and polygenic risk score based on a single nucleotide protein (SNP), and compared it to a PSA threshold of > 3ng/ml, with the STHLM3 showing an AUC of 0.76 for clinically significant cancer compared to 0.6 for PSA alone in this study
Summary
The WHO reminds us that screening starts with a ‘rough sorting process’, to identify those at higher risk of the target condition, followed by a diagnostic test, to determine whether the condition is present[1]. The European Randomised Screening for Prostate Cancer (ERSPC) is the only screening study to have shown a prostate cancer mortality reduction, with a 20% reduction at 16 year follow up[3].
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