{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T08:30:11Z","timestamp":1786437011410,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008730","name":"Kreftforeningen","doi-asserted-by":"publisher","award":["197950"],"award-info":[{"award-number":["197950"]}],"id":[{"id":"10.13039\/100008730","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","award":["R167\u2010A10920"],"award-info":[{"award-number":["R167\u2010A10920"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","award":["R175\u2010A11419"],"award-info":[{"award-number":["R175\u2010A11419"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Active surveillance (AS) is the preferred approach for low\u2010risk prostate cancer (PCa). Recent efforts have explored new biomarkers to reduce the frequency of surveillance biopsy. This study assessed Stockholm3 for predicting PCa upgrading during surveillance biopsies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>The prospective STHLM3\u2010AS NorDCaP trial included 199 men with International Society of Urological Pathologists grade group 1 (ISUP GG 1) PCa under AS in Sweden, Denmark, and Norway (2019\u20132022). All men had ISUP GG 1 PCa and received a Stockholm3 test before surveillance biopsies. The primary outcome was ISUP upgrading, defined as ISUP GG 2 or higher.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At surveillance biopsy, 72 of the 199 (36%) men were upgraded. Men with upgraded PCa had higher median Stockholm3 (35; interquartile range [IQR] 26\u201350) than those without upgrading (23; IQR 14\u201334,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). The area under the receiver operating characteristic curve (AUC) for Stockholm3 was 0.71 (95% confidence interval [CI] 0.64\u20130.79). For Stockholm3\u2009\u226515, sensitivity, specificity, and negative\u2010predictive value (NPV) were 0.93 (95% CI 0.85\u20130.98), 0.26 (95% CI 0.19\u20130.35), and 0.87 (95% CI 0.72\u20130.96), respectively, sparing 19% of biopsies while missing five cases (7% of upgrades), none of which were ISUP GG \u22653. At a lower threshold (\u226511), sensitivity increased to 0.99 (95% CI 0.93\u20131.00) with lower specificity (0.11; 95% CI 0.06\u20130.18) and an NPV of 0.93 (95% CI 0.68\u20131.00). Prostate\u2010specific antigen density \u22650.15 showed a sensitivity of 0.60 (95% CI 0.48\u20130.72), specificity of 0.72 (95% CI 0.63\u20130.80), and NPV of 0.75 (95% CI 0.66\u20130.83), with an AUC of 0.71 (95% CI 0.63\u20130.79). Prostate Imaging\u2010Reporting and Data System score \u22653 demonstrated a sensitivity of 0.92 (95% CI 0.83\u20130.97), specificity of 0.33 (95% CI 0.22\u20130.44), and NPV of 0.84 (95% CI 0.66\u20130.95), with an AUC of 0.72 (95% CI 0.65\u20130.79).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In men with low\u2010risk PCa under AS, Stockholm3 may enhance risk stratification and reduce unnecessary biopsies. Prostate\u2010specific antigen density and multiparametric magnetic resonance imaging showed comparable performance, with Stockholm3 providing a potentially practical blood\u2010based complement in a multimodal strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70366","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:37:11Z","timestamp":1782920231000},"page":"471-479","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>STHLM3 NorDCaP<\/scp>\n                    : prospective multicentre trial of Stockholm3 for active surveillance biopsy guidance"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9844-1799","authenticated-orcid":false,"given":"Nicola","family":"Giudici","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine and Surgery Karolinska Institutet  Stockholm Sweden"},{"name":"Department of 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