{"entity":{"id":"paper-eklund-sthlm3-mri-nejm-2021","kind":"paper","name":"MRI-targeted or standard biopsy in prostate cancer screening (STHLM3-MRI)","aka":[],"tldr":"In a Stockholm screening trial, sending men with a raised PSA for an MRI scan first, and biopsying only those whose scan looked suspicious, found as many important prostate cancers as biopsying all of them, and a third as many harmless ones.","summary":"A population-based non-inferiority trial from Karolinska Institutet. Men aged 50 to 74 were invited by post; of 12,750 enrolled, 1,532 had a PSA of 3 ng/mL or higher and were randomised 2:3 to standard biopsy (603) or to MRI with targeted and standard biopsy if the MRI suggested cancer (929). The primary outcome was the proportion with clinically significant cancer (Gleason score 7 or more) in the intention-to-treat population; the key secondary outcome was detection of clinically insignificant (Gleason 6) cancer.","asOf":"2026-11-03","links":[{"label":"NEJM 2021","url":"https://doi.org/10.1056/NEJMoa2100852"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/34237810/"}],"tags":[],"related":[],"cancers":["prostate"],"sections":["early-detection"],"technologies":["prostate-screening-psa-mri","mp-mri"],"targets":[],"drugs":[],"companies":[],"institutions":["karolinska","capio-st-goran"],"pathways":[],"terms":["psa","overdiagnosis"],"trials":["sthlm3-mri"],"people":["martin-eklund","henrik-gronberg"],"bottlenecks":["b-early-detection"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2021,"doi":"10.1056/NEJMoa2100852","pmid":"34237810","authors":"Eklund M, Jäderling F, Discacciati A, Bergman M, Annerstedt M, Aly M, Glaessgen A, Carlsson S, Grönberg H, Nordström T; STHLM3 consortium","paperType":"rct","findings":["Clinically significant cancer was diagnosed in 192 men (21 per cent) in the MRI group and 106 (18 per cent) in the standard biopsy group, a difference of 3 percentage points (95 per cent CI -1 to 7; P<0.001 for non-inferiority).","Clinically insignificant cancer fell from 12 per cent (73 men) with standard biopsy to 4 per cent (41 men) with the MRI pathway, a difference of -8 percentage points (95 per cent CI -11 to -5)."],"whatItMeans":"Overdiagnosis, finding cancers that would never have caused harm, is the main reason Sweden's health authority advises against PSA screening. This trial showed that putting an MRI before the biopsy keeps the detection of cancers that matter while cutting the harmless ones by about two thirds. Sweden's regions have since begun organised prostate cancer testing, which the regional cancer centres describe as making PSA testing more equal and structured and helping to evaluate complementary tests; Socialstyrelsen still distinguishes it from screening.","caveats":["One screening round in one city; it measures what was found, not deaths prevented.","Detection depends on the quality of MRI reading, which may be lower outside expert centres."],"participants":12750},"route":"/key-papers/paper-eklund-sthlm3-mri-nejm-2021/","neighbours":{"cancer":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"mp-mri","kind":"technology","name":"Multiparametric prostate MRI (PI-RADS)","route":"/technologies/mp-mri/"},{"id":"prostate-screening-psa-mri","kind":"technology","name":"PSA and MRI-first prostate cancer screening","route":"/technologies/prostate-screening-psa-mri/"}],"institution":[{"id":"capio-st-goran","kind":"institution","name":"Capio S:t Göran's Hospital","route":"/institutions/capio-st-goran/"},{"id":"karolinska","kind":"institution","name":"Karolinska University Hospital","route":"/institutions/karolinska/"}],"term":[{"id":"overdiagnosis","kind":"term","name":"Overdiagnosis","route":"/terms/overdiagnosis/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"}],"trial":[{"id":"sthlm3-mri","kind":"trial","name":"STHLM3-MRI (Stockholm3 and MRI-targeted biopsy in prostate cancer screening)","route":"/trials/sthlm3-mri/"}],"person":[{"id":"henrik-gronberg","kind":"person","name":"Henrik Grönberg","route":"/people/henrik-gronberg/"},{"id":"martin-eklund","kind":"person","name":"Martin Eklund","route":"/people/martin-eklund/"}],"bottleneck":[{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}