Prostate Cancer – Henrik Grönberg's research group

Main research area is prostate cancer genetics focusing on identifying new markers both for the risk of getting prostate cancer and for the prognosis of prostate cancer once diagnosed.

Part of the:

Our research

The ProBio study

Currently the main focus of the research group is the ProBio study. ProBio is an outcome-adaptive and randomised multi-arm biomarker driven study in patients with metastatic prostate cancer. 

The lack of treatment-predictive biomarkers is an unmet clinical need in metastatic prostate cancer leading to inferior clinical outcomes, overtreatment and accelerating costs. The ProBio concept builds on a novel adaptive study design and prospectively evaluates treatment predictive biomarker signatures in a large network of 35 study centers in Europe. 

By using the ProBio platform we are able to rapidly evaluate both new and old drugs in subsets of patients with a similar genomic biomarker. The aim is to give patients with metastatic prostate cancer an individualized treatment based on treatment-predictive genomic biomarker signatures in the near future.

STHLM3

STHLM3 was a large-scale prospective and population-based prostate cancer diagnostic trial involving close to 60, 000 men in Stockholm 2013-2015 with the aim of to develop and validate a model to identify high-risk prostate cancer with better test characteristics. Two screening methods, PSA and the Stockholm3 test, were assessed and compared for safety and efficacy. 

The primary aim of the STHLM3 trial was to investigate if the Stockholm3 test could substantially reduce the proportion of men undergoing prostate biopsy whilst maintaining the sensitivity for detecting consequential prostate cancer (Gleason Score 7 or above) compared to PSA. 

The results showed that the Stockholm3 test could reduce the number of unnecessary prostate biopsies by close to 50% and decrease indolent cancers (Gleason 6, typically regarded as overdiagnosed cancers) by 20%, without reducing the sensitivity to detect consequential prostate cancer compared to using the PSA. 

The data from the trial provides a fantastic resource for studying prostate cancer diagnostics, and has since the publication of the main results in the Lancet Oncology 2015 been used in a large number of follow-up publications.

The Stockholm3 test

The Stockholm3 test is a blood test developed in the research group that combines protein markers, genetic markers and clinical data with an advanced algorithm in order to detect aggressive prostate cancer at an early stage.

Publications

All publications from group members

Funding

Grants

Staff and contact

Group leader

All members of the group

Visiting address

Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Nobels väg 12A, Stockholm, 17177, Sweden

Postal address

Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, PO Box 281, Stockholm, 17177, Sweden

STHLM0

Logotype for the STHLM0 registry

STHLM0, the Stockholm Prostate Cancer Diagnostics Register, is a quality register managed by the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, Stockholm, Sweden. It is a unique quality register that includes all men tested for prostate cancer in Stockholm, Sweden.

STHLM0 Steering Committee

STHLM0 is managed by a steering committee, responsible for policy documents, major decisions, ethics committee applications, news circulation, applying for funding, and approving data access to entities working outside of Karolinska Institutet. 

Meet our core team working to maintain and update STHLM0.  

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Henrik Grönberg

Professor/Senior Physician
+46852482347
Department of Medical Epidemiology and Biostatistics
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Tobias Nordström

Affiliated to Research
Department of Clinical Sciences, Danderyd Hospital;Department of Medical Epidemiology and Biostatistics
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Markus Aly

Affiliated to Research
Department of Molecular Medicine and Surgery
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Martin Eklund

Professor
+46852482501
Department of Medical Epidemiology and Biostatistics
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Anna Lantz

Affiliated to Research
Department of Medical Epidemiology and Biostatistics;Department of Molecular Medicine and Surgery
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Mark Clements

Senior Lecturer
+46852482023
Department of Medical Epidemiology and Biostatistics
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Alessio Crippa

Senior Research Specialist
+46852482264
Department of Medical Epidemiology and Biostatistics
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Andrea Discacciati

Department of Medical Epidemiology and Biostatistics

Vivekananda Lanka

System Developer
+46852482499
Department of Medical Epidemiology and Biostatistics
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Klara Ernemo

Administrator
+46852482295
Department of Medical Epidemiology and Biostatistics

Visit us

The Department of Medical Epidemiology and Biostatistics

Visiting address: Nobels väg 12A, SE-171 65 Solna

Information on STHLM0

STHLM0 was developed with the aim of collecting demographic, clinical, and patient-outcomes information on all men tested for prostate cancer in Stockholm, Sweden. STHLM0 includes all men who have undertaken prostate cancer diagnostic testing in Stockholm since 2003. Our records go back to 2003, and are updated annually. STHLM0 got ethics committee approval, and has been continuously expanding to include additional variables that can be perform and advance research. 

Registers linked to STHLM0

STHLM0 collects original data on every PSA testing performed in Stockholm, MRI, prostatic biopsies, and other prostate cancer diagnostics. However, supplementary information from other registers is linked to STHLM0. Examples of linked registers: 

  • Swedish Patient Register  
  • Cause of Death Register
  • Swedish Cancer Register
  • Swedish Prescribed Drug Register
  • Swedish Population Register
  • Swedish Education Register
  • Swedish National Prostate Cancer Register  

Updating

STHLM0 gets updated annually. 

  • Data from the different laboratories are sent  every quarter
  • Data from the registers are updated once per year 

There is a one-year delay in collecting the cause of death data, but not the date of death. 

Request access and/or collaboration ideas

We welcome researchers from across Sweden and the globe to access our register. With more than 500,000 men followed up since 2003, we provide access to a unique dataset that can advance our understanding of prostate cancer epidemiology. 

If you are a research group and would like to suggest collaboration ideas, we welcome you to fill out the contact form link. 

All applications will be reviewed by the steering committee. Valid applications must fill out the specified form, and submit a short project plan (max of 400 words).

If you are requesting access to data, you should have got approval of the collaboration by the Steering Committee, and received Swedish ethics committee approval. Approvals from IRB/ethics committees from other countries will not be accepted. All the research conducted is done after approval from the Swedish ethics committee.

To request access to the data, please fill out the following form link.

Publications based on STHLM0

STHLM0 gives our research a unique opportunity in having a comprehensive population-based register of all men tested for prostate cancer in Stockholm region. Overall, more than 30 articles were published, and ongoing projects are planned using the register. 

Further information on STHLM0 is available in the register profile paper. 

Polygenic risk score improves prostate cancer risk prediction: results from the Stockholm-1 cohort study.
Aly M, Wiklund F, Xu J, Isaacs WB, Eklund M, D'Amato M, Adolfsson J, Grönberg H
Eur Urol 2011 Jul;60(1):21-8

Prostate-specific antigen (PSA) testing is prevalent and increasing in Stockholm County, Sweden, Despite no recommendations for PSA screening: results from a population-based study, 2003-2011.
Nordström T, Aly M, Clements MS, Weibull CE, Adolfsson J, Grönberg H
Eur Urol 2013 Mar;63(3):419-25

A genetic score can identify men at high risk for prostate cancer among men with prostate-specific antigen of 1-3 ng/ml.
Nordström T, Aly M, Eklund M, Egevad L, Grönberg H
Eur Urol 2014 Jun;65(6):1184-90

The risk of prostate cancer for men on aspirin, statin or antidiabetic medications.
Nordström T, Clements M, Karlsson R, Adolfsson J, Grönberg H
Eur J Cancer 2015 Apr;51(6):725-33

Rapid increase in multidrug-resistant enteric bacilli blood stream infection after prostate biopsy - A 10-year population-based cohort study.
Aly M, Dyrdak R, Nordström T, Jalal S, Weibull CE, Giske CG, Grönberg H
Prostate 2015 Jun;75(9):947-56

Comparison Between the Four-kallikrein Panel and Prostate Health Index for Predicting Prostate Cancer.
Nordström T, Vickers A, Assel M, Lilja H, Grönberg H, Eklund M
Eur Urol 2015 Jul;68(1):139-46

Risk of Prostate Cancer in Men Treated With 5α-Reductase Inhibitors-A Large Population-Based Prospective Study.
Wallerstedt A, Strom P, Gronberg H, Nordstrom T, Eklund M
J Natl Cancer Inst 2018 Nov;110(11):1216-1221

Poor Follow-up After Elevated Prostate-specific Antigen Tests: A Population-based Cohort Study.
Aly M, Clements M, Weibull CE, Nordström T, Näslund E, Adolfsson J, Grönberg H
Eur Urol Focus 2019 Sep;5(5):842-848

A natural history model for planning prostate cancer testing: Calibration and validation using Swedish registry data.
Karlsson A, Jauhiainen A, Gulati R, Eklund M, Grönberg H, Etzioni R, Clements M
PLoS One 2019 ;14(2):e0211918

A natural history model for planning prostate cancer testing: Calibration and validation using Swedish registry data.
Karlsson A, Jauhiainen A, Gulati R, Eklund M, Grönberg H, Etzioni R, Clements M
PLoS One 2019 ;14(2):e0211918

The impact of different prostate-specific antigen (PSA) testing intervals on Gleason score at diagnosis and the risk of experiencing false-positive biopsy recommendations: a population-based cohort study.
Palsdottir T, Nordstrom T, Karlsson A, Grönberg H, Clements M, Eklund M
BMJ Open 2019 Mar;9(3):e027958

Is there any association between prostate-specific antigen screening frequency and uptake of active surveillance in men with low or very low risk prostate cancer?
Beckmann K, Kinsella N, Olsson H, Wallerstedt Lantz A, Nordstrom T, Aly M, Adolfsson J, Eklund M, Van Hemelrijck M
BMC Urol 2019 Aug;19(1):73

Association Between Antidiabetic Medications and Prostate-Specific Antigen Levels and Biopsy Results.
Beckmann K, Crawley D, Nordström T, Aly M, Olsson H, Lantz A, Binti Abd Jalal N, Garmo H, Adolfsson J, Eklund M, Van Hemelrijck M
JAMA Netw Open 2019 Nov;2(11):e1914689

The economic burden of prostate cancer - a Swedish prevalence-based register study.
Hao S, Östensson E, Eklund M, Grönberg H, Nordström T, Heintz E, Clements M
BMC Health Serv Res 2020 May;20(1):448

Survival in patients diagnosed with castration-resistant prostate cancer: a population-based observational study in Sweden.
Aly M, Leval A, Schain F, Liwing J, Lawson J, Vágó E, Nordström T, Andersson TM, Sjöland E, Wang C, Eloranta S, Akre O
Scand J Urol 2020 Apr;54(2):115-121

Prognostic value of perineural invasion in prostate needle biopsies: a population-based study of patients treated by radical prostatectomy.
Ström P, Nordström T, Delahunt B, Samaratunga H, Grönberg H, Egevad L, Eklund M
J Clin Pathol 2020 Oct;73(10):630-635

Predictors of adverse pathology on radical prostatectomy specimen in men initially enrolled in active surveillance for low-risk prostate cancer.
Björnebo L, Olsson H, Nordström T, Jäderling F, Grönberg H, Eklund M, Lantz A
World J Urol 2021 Jun;39(6):1797-1804

Real world treatment utilization patterns in patients with castration-resistant prostate cancer.
Vigneswaran HT, Warnqvist A, Andersson TML, Leval A, Eklund M, Nordström T, Eloranta S, Schain F, Dearden L, Liwing J, Mehra M, Nair S, Pettersson A, Akre O, Aly M
Scand J Urol 2021 Aug;55(4):299-306

The cost-effectiveness of prostate cancer screening using the Stockholm3 test.
Karlsson AA, Hao S, Jauhiainen A, Elfström KM, Egevad L, Nordström T, Heintz E, Clements MS
PLoS One 2021 ;16(2):e0246674

Mortality in men with castration-resistant prostate cancer-A long-term follow-up of a population-based real-world cohort.
Khoshkar Y, Westerberg M, Adolfsson J, Bill-Axelson A, Olsson H, Eklund M, Akre O, Garmo H, Aly M
BJUI Compass 2022 Mar;3(2):173-183

Cardiovascular, bone, and metabolic health in men with castrate-resistant prostate cancer treated with androgen deprivation: a matched cohort study.
Khoshkar Y, Vigneswaran HT, Eloranta S, Andersson TM, Schain F, Boman A, Dahlkild M, Liwing J, Leval A, Akre O, Aly M
Acta Oncol 2022 Nov;61(11):1377-1385

Modeling Disease Trajectories for Castration-resistant Prostate Cancer Using Nationwide Population-based Data.
Ventimiglia E, Bill-Axelson A, Adolfsson J, Aly M, Eklund M, Westerberg M, Stattin P, Garmo H
Eur Urol Open Sci 2022 Oct;44():46-51

Association of 5α-Reductase Inhibitors With Prostate Cancer Mortality.
Björnebo L, Nordström T, Discacciati A, Palsdottir T, Aly M, Grönberg H, Eklund M, Lantz A
JAMA Oncol 2022 Jul;8(7):1019-1026

Cost-Effectiveness of the Stockholm3 Test and Magnetic Resonance Imaging in Prostate Cancer Screening: A Microsimulation Study.
Hao S, Heintz E, Östensson E, Discacciati A, Jäderling F, Grönberg H, Eklund M, Nordström T, Clements MS
Eur Urol 2022 Jul;82(1):12-19

Time to castration-resistant prostate cancer and prostate cancer death according to PSA response in men with non-metastatic prostate cancer treated with gonadotropin releasing hormone agonists.
Bonde TM, Westerberg M, Aly M, Eklund M, Adolfsson J, Bill-Axelson A, Garmo H, Stattin P, Robinson D
Scand J Urol 2022 Jun;56(3):169-175

Cost-Effectiveness Analysis of Prostate Cancer Screening in the UK: A Decision Model Analysis Based on the CAP Trial.
Keeney E, Sanghera S, Martin RM, Gulati R, Wiklund F, Walsh EI, Donovan JL, Hamdy F, Neal DE, Lane JA, Turner EL, Thom H, Clements MS
Pharmacoeconomics 2022 Dec;40(12):1207-1220

Cost-effectiveness of Prostate Cancer Screening Using Magnetic Resonance Imaging or Standard Biopsy Based on the STHLM3-MRI Study.
Hao S, Discacciati A, Eklund M, Heintz E, Östensson E, Elfström KM, Clements MS, Nordström T
JAMA Oncol 2022 Nov;9(1):88-94

Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy.
Falagario UG, Abbadi A, Remmers S, Björnebo L, Bogdanovic D, Martini A, Valdman A, Carrieri G, Menon M, Akre O, Eklund M, Nordström T, Grönberg H, Lantz A, Wiklund P
JAMA Netw Open 2023 Sep;6(9):e2332900

Effectiveness and Cost-effectiveness of Artificial Intelligence-assisted Pathology for Prostate Cancer Diagnosis in Sweden: A Microsimulation Study.
Du X, Hao S, Olsson H, Kartasalo K, Mulliqi N, Rai B, Menges D, Heintz E, Egevad L, Eklund M, Clements M
Eur Urol Oncol 2025 Feb;8(1):80-86

Spatio-temporal variation in prostate cancer testing in Stockholm: A population-based study.
Rai B, Nordström T, Lantz A, Lund RL, Kuja-Halkola R, Rado M, Öberg S, Hao S, Du X, Clements M
PLoS One 2024 ;19(8):e0308254

Prostate cancer incidence and mortality in men exposed to α1-adrenergic receptor antagonists.
Björnebo L, Razdan S, Discacciati A, Palsdottir T, Aly M, Nordström T, Eklund M, Lundon D, Grönberg H, Tewari A, Wiklund P, Kyprianou N, Lantz A
J Natl Cancer Inst 2024 Sep;116(9):1459-1465

Keywords:
Adaptive Clinical Trial Bioinformatics (Computational Biology) (Applications at 10610) Biomarkers, Tumor Cancer and Oncology Epidemiology Show all
Content reviewer:
Henrik Grönberg
Gunilla Sonnebring
12-06-2025
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