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This report reviews the Stockholm3 test offered through A3P Biomedical AB

It also summarizes the UK NICE Medtech Innovation Briefing (MIB303) on the technology, and discusses potential “Not Invented Here” (NIH) attitudes in the NICE evaluation process.

It is intended to inform discussions at a meeting on advancing prostate cancer screening strategies in the NHS.Executive

Summary

Stockholm3 is a promising blood-based risk stratification test for prostate cancer, combining protein biomarkers, genetic markers, and clinical data to improve upon PSA testing by reducing unnecessary biopsies and MRIs while maintaining sensitivity for clinically significant cancers.

Offered commercially by A3P Biomedical AB, it shows strong evidence from international studies for cost savings and better detection rates.

NICE’s 2022 briefing acknowledges these benefits but calls for UK-specific research before NHS adoption, potentially reflecting an NIH bias favouring domestically developed or validated technologies.

Recommendations include exploring pilot implementations and addressing evidence gaps to overcome adoption barriers.

Availability in UK

The Stockholm3 test is immediately available in the UK via:

Medical Diagnosis Ltd

https://www.medical-diagnosis.co.uk/stockholm3/

They are a UKAS accredited laboratory, with 2 clinics in London and nationwide phlebotomy services

1. Review of Tests Offered by A3P Biomedical AB (https://www.a3p.com)

A3P Biomedical AB specializes in precision diagnostics for early detection of aggressive prostate cancer, positioning itself as a leader in reducing overdiagnosis and unnecessary interventions.

The company’s website emphasizes the global burden of prostate cancer—the most common cancer in men—and highlights the importance of early, targeted detection to improve outcomes.

Key Offerings and Focus on Stockholm3

• Primary Test: Stockholm3
  While the website does not provide granular technical details (e.g., exact biomarkers or algorithms), it focusses on Stockholm3 as its flagship product for prostate cancer risk assessment.
• This CE-marked (with planned UKCA marking) blood test is designed for men aged 45–74 with elevated PSA (≥1.5 ng/ml) and no prior diagnosis.
• It integrates:
  • Five plasma protein biomarkers  (e.g., total PSA, free PSA, hK2, MSMB, MIC1).

• • 101 genetic single nucleotide polymorphisms (SNPs).

• • Clinical variables (age, family history, prior biopsy). The output is a risk score (≥11% threshold typically triggers further evaluation like MRI or biopsy).
• • It is performed in accredited reference laboratories, with results supporting decisions in primary or secondary care.
• Other Tests/Services
  The site does not explicitly list additional tests beyond Stockholm3. Instead, it frames its portfolio around oncology-focused precision medicine, with an emphasis on prostate cancer. Broader services may include consulting on implementation in healthcare systems, but no details on pricing, availability in the UK, or complementary assays (e.g., for other cancers) are provided.
• Logistics involve standard phlebotomy and sample transport, potentially integrated into existing care pathways.

2. Evidence and Benefits Highlighted by A3P

A3P cites aggregated clinical data from over 90,000 participants across studies, underscoring Stockholm3’s performance:

• Detection Improvements: 41–89% more aggressive (clinically significant) cancers identified compared to PSA alone.
• Reduction in Harms: 37–52% fewer unnecessary biopsies, lowering risks like infection and sepsis.
• Economic Impact: 8–28% reduction in healthcare costs through streamlined diagnostics.

Availability appears targeted at European markets (e.g., Sweden, Norway), with growing interest in the UK via partnerships.

No UK-specific pricing is listed, but NICE estimates £350 per test (excluding VAT, with volume discounts).

A3P positions Stockholm3 as a “game-changer” for high-risk groups, including those with family history or African ancestry, though evidence in diverse populations remains limited.

Limitations in Review: The website is promotional and lacks in-depth clinical protocols or comparative data, directing users to peer-reviewed studies for validation.

3. Review of the NICE Briefing (MIB303)

The National Institute for Health and Care Excellence (NICE) published Medtech Innovation Briefing 303 on August 9, 2022, evaluating Stockholm3 for prostate cancer risk prediction in unscreened men aged 45–74 with PSA ≥1.5 ng/ml.

The briefing is not a formal guidance document but an overview to inform NHS decision-makers on innovative technologies.

Overall, the briefing is cautiously positive, highlighting Stockholm3’s alignment with NHS goals (e.g., reducing pathology burden) but emphasizing evidence gaps.

Key Sections and Findings of NICE Briefing (MIB303)

4. Discussion of the “Not Invented Here” Attitude in NICE

The “Not Invented Here” (NIH) syndrome refers to organizational resistance to external innovations, often due to perceived lack of control, unfamiliarity, or bias toward in-house developments.

In the context of NICE’s evaluation of Stockholm3—a Swedish-originated technology commercialized by A3P—elements of NIH may manifest in the briefing’s structure and conclusions, potentially hindering timely NHS adoption of a globally validated tool.

Evidence of NIH in the NICE Briefing

• Overemphasis on Lack of UK Data: Despite robust international evidence (e.g., Norwegian implementation reducing referrals by 28% and costs by 23–28%), NICE repeatedly flags the absence of UK-specific studies as a primary limitation. This includes homogenous (non-diverse) study populations and non-NHS settings, leading to calls for “prospective NHS-specific comparative studies.” While valid for applicability, this sets a high bar not always applied uniformly to other imports (e.g., faster adoption of US-developed PSA assays). Ongoing UK-relevant trials (e.g., NCT04583072) are noted but deemed insufficient for immediate use.
• Procedural and Cultural Barriers: The briefing underscores undefined pathway integration and infrastructure needs (e.g., UKAS-accredited labs), which could be addressed via pilots but are framed as systemic hurdles. Expert comments reveal no direct UK experience with Stockholm3, reinforcing a cycle of unfamiliarity. Prostate Cancer UK highlights patient benefits, yet NICE’s stance prioritizes caution over innovation, echoing NIH by deferring to “homegrown” validation.
• Broader Context in NICE and NHS: NICE’s Medtech Innovation Briefings aim to accelerate uptake, but Stockholm3’s non-endorsement contrasts with quicker integrations of UK/EU-aligned tech (e.g., MRI advancements). Post-2022, no major updates indicate adoption; a 2025 search yields no new NICE guidance, suggesting persistent inertia. This may stem from resource constraints or a cultural preference for technologies with established NHS footprints, as seen in critiques of NICE’s slow uptake of AI diagnostics or foreign biomarkers.

Implications and Counter arguments

An NIH attitude risks delaying benefits: Stockholm3 could address NHS backlogs (e.g., biopsy waits) and equity issues in high-risk groups, with modelled savings of €6,000–170,000 per QALY.

However, NICE’s caution is defensible given PSA’s historical harms and the need to avoid uncritical imports.

To mitigate NIH:

• Advocate for accelerated UK pilots (e.g., in secondary care for low-PSA cases).
• Leverage post-briefing data from ongoing trials.
• Foster collaborations with A3P for localized validation.

This discussion underscores the tension between evidence-based prudence and innovation-friendly policies.

Recommendations for the Meeting

1. Pilot Proposal: Discuss a small-scale NHS trial integrating Stockholm3 as a PSA reflex test, targeting high-risk cohorts to generate local data.
2. Stakeholder Engagement: Invite A3P representatives and patient groups to address NIH perceptions and pathway barriers.
3. Research Agenda: Prioritize funding for diverse-ethnicity studies to bridge NICE’s evidence gaps.
4. Policy Advocacy: Explore incentives for faster Medtech adoption, reducing NIH biases.

References:

• A3P Biomedical AB Website (browsed November 2025).
• NICE MIB303 (August 2022).
• Peer-reviewed studies cited in MIB303 (e.g., Nordström et al., 2021).