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A Stockholm trial that invited men from the general population for prostate testing and asked whether using an MRI scan to decide who needs a biopsy finds as many important cancers as biopsying everyone with a raised PSA. It did, and it found about a third as many harmless cancers.
STHLM3-MRI enrolled 12,750 men aged 50 to 74 invited by post from the general population. The 1,532 with a PSA of 3 ng/mL or higher were randomised 2:3 to a standard biopsy (603) or to MRI followed by targeted and standard biopsy only if the scan suggested cancer (929). In the intention-to-treat analysis clinically significant cancer (Gleason score 7 or more) was found in 21 per cent of the MRI group and 18 per cent of the standard group, meeting the non-inferiority margin, while clinically insignificant cancer fell from 12 to 4 per cent. The trial also tested the Stockholm3 blood-based risk score, developed in the earlier STHLM3 study, and a two-year follow-up of the baseline round was published in 2026. It was funded by the Swedish Research Council and others.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
12,750 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Clinically significant prostate cancer (Gleason 7 or more) detectedprimary | MRI with targeted and standard biopsy | 929 | 21% | - | - | link |
| Standard biopsy | 603 | 18% | ||||
| Clinically insignificant prostate cancer (Gleason 6) detected | MRI with targeted and standard biopsy | 929 | 4% | - | - | link |
| Standard biopsy | 603 | 12% |
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.
It showed in a general population, not a referred clinic population, that a multi-marker risk score could spare many men a biopsy without missing more of the cancers that matter. The same group then tested the score inside the STHLM3-MRI screening trial.
Shares Multiparametric prostate MRI (PI-RADS), PSA and MRI-first prostate cancer screening, Overdiagnosis, PSA (prostate-specific antigen).
Shares Henrik Grönberg, Martin Eklund.
Shares Prostate cancer screening in men aged 50-69 years (STHLM3): a prospective population-based diagnostic study, PSA and MRI-first prostate cancer screening, Overdiagnosis, PSA (prostate-specific antigen).
Shares Overdiagnosis, PSA (prostate-specific antigen), Prostate cancer.
Shares Henrik Grönberg, Martin Eklund, Karolinska University Hospital.
Shares PSA and MRI-first prostate cancer screening, Overdiagnosis, PSA (prostate-specific antigen), The hardest cancers are found late.
Shares Multiparametric prostate MRI (PI-RADS), PSA and MRI-first prostate cancer screening, Prostate cancer.
Shares PSA and MRI-first prostate cancer screening, Overdiagnosis, PSA (prostate-specific antigen), The hardest cancers are found late.
Every source this page cites, grouped by who published it. Grouping is read from the web address, not assigned by hand.
A source that has moved or gone is reported by the weekly link check. /audit/