ArticleEuropean urology2024
Performance of 4Kscore as a Reflex Test to Prostate-specific Antigen in the GÖTEBORG-2 Prostate Cancer Screening Trial.
Article in European urology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 15 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomized Controlled Trial of Anti-inflammatory Medications in Patients With Elevated Serum Prostate-specific Antigen
Investigation of an Intelligent Centre-adaptive Multi-modal Fusion Framework (Cad- MMFF) to Overcome Unnecessary Prostate Biopsies and Optimize MRI Utilization: a Hybrid Retrospective-prospective Study
Who cites it
15 citing papers in PubMed.
- Recent advances in discriminating prostate cancer from benign prostatic diseases in the pre-biopsy population.Medical oncology (Northwood, London, England) · 2026Review
- A serum-clinical composite model for prostate cancer diagnosis: multicenter validation and CRISPR/Cas13a-based detection.The journal of liquid biopsy · 2026Article
- Evolving role of biomarkers beyond prostate‑specific antigen in refining prostate cancer screening: From blood‑based tests to urinary and genetic markers (Review).Molecular medicine reports · 2026Review
- Context-aware monitoring: rethinking comprehensive screening in the era of AI.NPJ digital medicine · 2026Article
- Early-Onset Prostate Cancer: Epidemiology, Risk Factors, Biology, Clinical Features, Management, and Early Detection.MedComm · 2026Review
- Prostate-Specific Antigen Screening Patterns and Metastatic Prostate Cancer in US Veterans.JAMA network open · 2026Article
- [Reducing overdiagnosis-how to do I correctly assess the indication for prostate biopsy?]Urologie (Heidelberg, Germany) · 2026Review
- A Feasibility study of a two-step ADC-PSAD-GWR rule for stratifying prostate lesions prior to biopsy.BMC medical imaging · 2026Article
- Prostate Cancer Screening in Contemporary Era: PSA-Based Testing and Risk-Adapted Approaches.Cancers · 2026Review
- Blood inflammatory markers combined with tumor markers for differentiating benign prostatic hyperplasia from prostate cancer.Frontiers in medicine · 2026Article
- Emerging tools for the early detection of prostate cancer.BJUI compass · 2025Review
- Biomarkers in Localized Prostate Cancer: From Diagnosis to Treatment.International journal of molecular sciences · 2025Review
- A machine learning-based screening model for the early detection of prostate cancer developed using serum microRNA data from a mixed cohort of 8,741 participants.Discover oncology · 2025Article
- An Artificial Intelligence Model Using Diffusion Basis Spectrum Imaging Metrics Accurately Predicts Clinically Significant Prostate Cancer.The Journal of urology · 2025Article
- Clinical assessment of urinary prostate cancer antigen 3 in Chinese population: a large-scale, prospective and multicenter study.World journal of surgical oncology · 2024Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
BACKGROUND AND
objectiveWe investigated whether adding 4Kscore as a reflex test to prostate-specific antigen (PSA) could improve the screening algorithm for prostate cancer (PC).
methodsIn the GÖTEBORG-2 PC screening trial, 38 000men (50-60 yr) were invited to PSA testing and, if elevated, followed by magnetic resonance imaging (MRI). For 571 men with PSA ≥3.0 ng/ml and evaluable outcomes, 4Kscore was calculated. The performance using a prespecified 4Kscore cutoff of 7.5% was evaluated. KEY FINDINGS AND LIMITATIONS: The area under the curve for 4Kscore to identify intermediate- and high-risk PC was 0.84 (95% confidence interval 0.79-0.89), and the positive predictive value, and negative predictive value were 15% (0.12-0.20) and 99% (97-100%), respectively. Of the 54 men diagnosed with intermediate- or high-grade PC, two had a 4Kscore cutoff below 7.5%, both with organ-confined intermediate-risk PC. Per 1000 men with elevated PSA, adding 4Kscore would have resulted in avoidance of MRI for 408 (41%) men, biopsies for 95 (28% reduction) men, and diagnosis of 23 low-grade cancers (23% reduction) while delaying the diagnosis of four men with intermediate-grade cancers (4%). CONCLUSIONS AND CLINICAL IMPLICATIONS: Including 4Kscore as a reflex test for men with elevated PSA reduces the need for MRI and biopsy markedly, and results in less overdiagnosis of low-grade PC at the cost of delaying the diagnosis of intermediate-grade PC in a few men. These results add further evidence for including new blood-based biomarkers in addition to PSA to improve the harm and benefit ratio of PC screening and reduce the need for resource-demanding MRI and biopsies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.