The Capio Prostate Cancer Center model for prostate cancer diagnostics using Stockholm3, MRI, and targeted biopsies: Real-world evidence from 2018 to 2022.

Abstract

295 Background: The Capio Prostate Cancer Center (Capio PCC) handles approximately 25% of prostate cancer care in Stockholm, Sweden. The Capio PCC Model utilizes Stockholm3 and MRI scans to assess prostate cancer risk, followed by targeted and systematic biopsies for those at increased risk. This study describes the clinical process and real-world evidence of the Capio PCC Model. Methods: If eligible for prostate cancer testing, men undergo a blood test for PSA. Men with PSA ≥1.5 ng/ml are additionally tested with Stockholm3 and men with a Stockholm3 ≥15, undergo MRI. Men with elevated risk on MRI undergo targeted and systematic biopsies. Men were included from 2018-2022 at the Capio PCC, if they underwent PSA and Stockholm3 (for PSA ≥1.5 ng/ml). The results on PSA, Stockholm3, MRI, and biopsies are presented, including the number of clinically significant prostate cancer as defined as ISUP grade ≥2. We compare the biopsy results from Capio PCC to other hospital regions in Sweden and evaluate health economics of the diagnostic pathway. Results: A total of 12,406 men aged 45-75 underwent testing for prostate cancer. Median age was 61 years (IQR: 55-67), median PSA was 1.6 ng/ml (IQR: 0.8 – 3.3), median Stockholm3 was 4 (IQR: 3-11) and 1,064 (8.6%) men were biopsied. A total of 611 (57% of biopsied) men were diagnosed with clinically significant prostate cancer. Of the tested men, 3,496 had PSA ≥3 ng/ml and 2,002 had Stockholm3 ≥15, decreasing the number MRIs by 43%. In total, 2,980 men had PSA between 1.5-2.99 ng/ml and of those, 360 (12%) had Stockholm3 ≥15 with 72 (56% of biopsied) men having clinically significant prostate cancer. In total, 330 men had PSA ≥10 ng/ml and of those, 87 men (26%) had Stockholm3 <15, reducing MRI and biopsy in this higher risk group. Comparing national Swedish prostate cancer data, the Capio PCC Model showed fewer diagnoses of low-risk cancers (14% vs. 25%), more intermediate risk cancers (59% vs. 42%), and less high-risk and advanced cancers (26% vs. 30%). Conclusions: The study demonstrates that the protocol-driven and diagnostic process at Capio PCC leads to an effective care, enabling earlier diagnosis of intermediate risk cancer and reducing the number of MRIs as well as incidence of overdiagnosis of low-risk cancers compared to the prostate cancer care in Sweden.[Table: see text]