Stockholm3 represents a risk model that integrates the prostate-specific antigen (PSA) test, other plasma protein biomarkers, single nucleotide polymorphisms, and clinical variables. In this study, experts evaluated the cost-effectiveness of magnetic resonance imaging (MRI)-based screening for prostate cancer employing either Stockholm3 as a reflex test or PSA alone.

• In the STHLM3-MRI study, it was revealed that Stockholm3 test with MRI and combined targeted and systematic biopsies maintained the sensitivity for clinically significant malignancies, and decreased the number of benign biopsies and clinically insignificant cancers.

• From a lifetime societal viewpoint, a cost-utility analysis was conducted employing a microsimulation model for men aged 55–69 yr in Sweden.

• Relative to no screening, it was predicted that the screening strategies would decrease prostate cancer deaths by 7–9% across a lifetime.

• A 60% reduction in MRI was achieved by using Stockholm3 with PSA ≥2 ng/ml vs screening using PSA.

• Cost-effectiveness of this Stockholm3 strategy was evident, with a probability of 70% at a cost-effectiveness threshold of €47,218 (500,000 Swedish Kronor).

• Overall, screening with the Stockholm3 test at a reflex threshold of PSA ≥2 ng/ml and MRI was predicted to be cost-effective in Sweden.