ArticleProstate international2026
Omitting biopsy in Prostate Imaging Reporting and Data System 3? The role of Stockholm3 and prostate-specific antigen density findings from a prospective Swiss non-referral cohort.
Article in Prostate international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Prostate Imaging Reporting and Data System (PI-RADS) 3 ("equivocal") prostate magnetic resonance imaging (MRI) lesions pose a diagnostic challenge, particularly in non-referral settings with variable MRI quality. We evaluated whether prostate-specific antigen density (PSAD) and the Stockholm3 blood test can aid biopsy decisions for men with PI-RADS 3 lesions in a prospective, non-referral Swiss cohort. Methods: Retrospective analysis of a prospective registry at a non-referral urology practice in Switzerland. From 2023 to 2025, men with PSA >1.5 ng/mL or suspicious digital rectal examination underwent Stockholm3 testing, MRI, and MRI-fusion plus systematic prostate biopsy. Clinically significant prostate cancer (csPCa) was defined as the International Society of Urological Pathology (ISUP) grade ≥2. Diagnostic accuracy and decision curve analysis compared Stockholm3 (≥13%, ≥15%, and ≥18%) and PSAD thresholds (0.10, 0.15, and 0.20 ng/mL/cc) within the PI-RADS 3 subgroup. Results: Overall, 50 of 174 (29%) men had PI-RADS 3 lesions, 59 of 174 (34%) were diagnosed with csPCa. Among PI-RADS 3 lesions, csPCa prevalence was 14%. Outcome distributions shifted toward higher ISUP grades with increasing PSAD thresholds when compared to the baseline (≥0.15 ng/mL/cc: 44% ISUP≥2; Conclusion: In non-referral practice, Stockholm3 did not reliably exclude csPCa among men with PI-RADS 3 lesions. PSAD-based triage, particularly at ≥0.15 ng/mL/cc, showed superior diagnostic utility and may support safe biopsy deferral in selected cases. Prospective validation in broader non-referral settings is warranted.
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