Advancements in Prostate Cancer Screening: PSA, Risk Models, and Genomic Innovations

Stockholm3, paired with PSA screening, improves detection of clinically significant prostate cancer while reducing overdiagnosis and unnecessary procedures — reframing follow-up decisions after an elevated PSA.

Recent validations show that the Stockholm3 test, when integrated with PSA, changes the screening signal clinicians receive: risk stratification shifts the balance toward identifying aggressive disease without increasing overtreatment.

Large randomized screening trials and modeling studies suggest PSA-based screening can lower prostate-cancer–specific mortality, but benefits are offset by overdiagnosis and downstream overtreatment that degrade quality of life and raise health-system use. The net population benefit therefore depends on targeting.

Multivariable risk models and genomic blood tests — including the Stockholm3 (STHLM3) model evaluated in about 59,088 men — combine protein markers, a polygenic score, and clinical and demographic variables to refine prebiopsy risk estimates and stratify patients beyond a single PSA value.

When baseline screening incorporates refined risk stratification, biochemical recurrence is better anticipated because prediagnostic risk more accurately predicts who is prone to early recurrence and who is unlikely to progress. That more precise baseline assessment informs surveillance intensity, biochemical-monitoring schedules, thresholds for biopsy, and selection for active surveillance.

Key Takeaways:

• Combining PSA with validated risk-stratification tools increases detection of clinically significant cancers while lowering overdiagnosis—supporting piloted adoption of risk-based screening workflows.
• Men undergoing PSA screening are directly affected; clinicians and diagnostic services should expect changes in biopsy volumes, follow-up intensity, and resource use.
• Implement selective use of multivariable or genomic risk tests to guide biopsy thresholds and surveillance decisions, and monitor outcomes to refine local thresholds and care pathways.