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Ethnic variation in prostate cancer detection: a feasibility study for use of the Stockholm3 test in a multiethnic U.S. cohort

Prostate Cancer and Prostatic Diseases volume 24, pages 120–127 (2021)Cite this article

Subjects

Abstract

Background

The Stockholm3 test improves Gleason Grade Group ≥2 (GG ≥ 2) prostate cancer (PC) detection, however it has not been evaluated in an American cohort where clinical practice patterns and ethnicity differ. We aimed to identify subgroups within a Stockholm population with PC risk profiles matching American ethnicity-specific subgroups and compare the detection of PC and describe Stockholm3 performance within these subgroups.

Methods

All men age 49–70 years presenting for prostate biopsies were evaluated at UIC from 2016 to 2019, as well as men in Stockholm from 2012 to 2014 in the STHLM3 study. Propensity scores (PS) were estimated for each person using logistic regression for age, PSA, prostate volume, family history of PC, 5-alpha reductase inhibitor use, and prior biopsy. 3:1 PS matching was performed for Stockholm to Chicago ethnicity-specific cohorts and odds ratios (OR) were computed to compare detection of GG ≥ 2 PC between groups.

Results

504 Chicago men and 6980 Stockholm men were included. In African American (AA) men, 51% had GG ≥ 2 PC detected, while in risk-matched Stockholm men, 34% had GG ≥ 2 PC detected (OR: 2.1, p < 0.001). There was no statistical difference in GG ≥ 2 PC detected when matching Stockholm men to non-Hispanic Caucasian men (31% vs. 24%, OR: 0.7, p = 0.30) or Hispanic Caucasian men (31% vs. 27%, OR: 1.2, p = 0.42). The AUC for the Stockholm3 test of the matched Stockholm cohorts for AA, non-Hispanic Caucasian, and Hispanic Caucasian men was 0.85, 0.89, and 0.90, respectively.

Conclusions

Using statistical techniques to simulate a multi-ethnic Chicago cohort within the STHLM3 population, we found an excess risk of GG ≥ 2 PC among AA men. Our hypothesis that the Stockholm3 may have good predictive value in a multiethnic cohort is strengthened, and that recalibration to at least AA men seems likely to be needed to obtain well-calibrated predictions.

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Fig. 1: Consort diagram for inclusion.
Fig. 2: Prostate Cancer detection among different ethnicities.
Fig. 3: Prostate Cancer Discrimination analysis with the Stockholm3 test.

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Acknowledgements

We thank Patrice King-Lee for data collection.

Funding

We recieved funding from Stockholm County Council, Cancerfonden, Swedish Research Council.

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Authors and Affiliations

  1. Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60607, USA

    Hari T. Vigneswaran & Michael R. Abern

  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Solna, Sweden

    Hari T. Vigneswaran, Andrea Discacciati, Henrik Grönberg & Martin Eklund

  3. Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60607, USA

    Peter H. Gann

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  1. Hari T. Vigneswaran
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Correspondence to Hari T. Vigneswaran.

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Conflict of interest

Dr. HG has five prostate cancer diagnostic–related patents pending, has patent applications licensed to Thermo Fisher Scientific, and might receive royalties from sales related to these patents. Dr. ME has five prostate cancer diagnostic–related patents pending. Karolinska Institutet collaborates with Thermo Fisher Scientific in developing the technology for the Stockholm3 test. The remaining authors declare that they have no conflict of interest.

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Vigneswaran, H.T., Discacciati, A., Gann, P.H. et al. Ethnic variation in prostate cancer detection: a feasibility study for use of the Stockholm3 test in a multiethnic U.S. cohort. Prostate Cancer Prostatic Dis 24, 120–127 (2021). https://doi.org/10.1038/s41391-020-0250-2

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