TABLE 1.
Summary of key results of various decision‐making approaches
| Risk stratification tools (cut‐off) | Setting | References | Reduced biopsies (%) | Reduced indolent PCa diagnosis (%) | Missed csPCa (%) |
|---|---|---|---|---|---|
| Univariable | |||||
| PSA test (≥3.0 ng/mL) a | Population based screening | 5, 9, 12, 15, 16 | N/A | N/A | N/A |
| MRI in triage setting (≥PI‐RADS 3) | Clinical suspicion | 50‐52 | 27‐29 | 20 | 3‐7 |
| Multivariable | |||||
| RPCRC (compared to PSA ≥3.0 ng/mL) | Clinical suspicion + biopsy naive | 41 | 33 | 14 | 7 |
| RPCRC (compared to PSA ≥3.0 ng/mL) | Clinical suspicion + prior negative biopsy | 41 | 37 | 16 | 9 |
| RPCRC (≥4%) | Clinical suspicion | 47 | 32 | 25 | 5 |
| PCPTRC 2.0 (≥4%) | Clinical suspicion | 47 | 16 | 15 | 3 |
| RPCRC + MRI (≥5%) | Clinical suspicion + biopsy naive | 65 | 2 | 10 | 15 |
| RPCRC + MRI (≥5%) | Clinical suspicion + prior negative biopsy | 65 | 27 | 14 | 3 |
| PHI (90% sensitivity) | Clinical suspicion | 75, 81 | 30‐56 | 31‐33 | 5–11 |
| 4K score (≥20%) | Clinical suspicion + biopsy naive | 90 | 74 | 38 | 26 |
| 4K score (≥20%) | Clinical suspicion + prior negative biopsy | 90 | 41 | 73 | 2 |
| STHLM3 risk‐based model (≥10%) | Clinical suspicion | 108, 110 | 32‐53 | 17‐76 | 0 |
Note: Head to head comparisons cannot be made based on the data in this table and performance of risk stratification tools should be confirmed in an external validation.
a
In the population‐based screening studies there were no biopsies performed if the PSA was lower than 3.0 ng/mL. Therefore, it is not possible to assess the missed cancers following this strategy.