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. 2025 Jun;85(8):784-791.
doi: 10.1002/pros.24886. Epub 2025 Mar 3.

Prostate Specific Antigen Density and Clinically-Significant Prostate Cancer: The Influence of Prostatic Volume

Elizabeth Robinson  1 , Netty Kinsella  2 , Derfel Ap Dafydd  1 , Joshua Shur  1 , Aslam Sohaib  1 , Steve Hazell  3 , Paul Bassett  4 , Pardeep Kumar  2 , Erik Mayer  2   5   6 , Declan Cahill  2 , Samuel J Withey  1
Affiliations

Prostate Specific Antigen Density and Clinically-Significant Prostate Cancer: The Influence of Prostatic Volume

Elizabeth Robinson et al. Prostate. 2025 Jun.

Abstract

Background: Prostate specific antigen density (PSAd) is one of the strongest predictors of clinically-significant prostate cancer (csPCa) in risk calculators. There is little evidence on the effect of prostate volume on the diagnostic performance of PSAd. Our aim was to define the diagnostic accuracy of PSAd for predicting csPCa across prostate volumes.

Methods: 548 patients who underwent magnetic resonance imaging (MRI) and biopsy were included in this retrospective study. Patients were grouped by prostate volume; small (≤ 30 mL), medium (> 30 to < 50 mL), large (≥ 50 mL). Sensitivity and specificity of PSAd were assessed at thresholds of ≥ 0.10, ≥ 0.15, and ≥ 0.20 ng/mL/mL for two definitions of csPCa.

Results: At all PSAd thresholds and for both definitions of csPCa, there was a statistically significant and clinically-relevant difference in diagnostic performance across prostate volume groups. Sensitivity was highest in small glands, lowest in large glands; the opposite being true for specificity. Using a PSAd threshold of ≥ 0.15 ng/mL/mL, sensitivity for ISUP grade ≥ 2 PCa was 83.1%, 63.6%, and 33.3% for small, medium and large prostates (p ≤ 0.001) with specificities of 48.5%, 67.5% and 79.3%, respectively (p = 0.005).

Conclusions: Diagnostic performance of PSAd varied significantly by prostate volume, and by applying a single PSAd threshold across all prostate volumes risks missing csPCa in men with larger glands, whilst performing unnecessary biopsies in those with smaller glands. Defining PSAd thresholds according to prostate volume categories can therefore improve its use as a risk predictor for csPCa.

Keywords: PSA density; adenocarcinoma; diagnostic accuracy; prostate; prostate specific antigen; prostate volume.

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References

    1. H. Van Poppel, M. J. Roobol, C. R. Chapple, et al., “Prostate‐Specific Antigen Testing as Part of a Risk‐Adapted Early Detection Strategy for Prostate Cancer: European Association of Urology Position and Recommendations for 2021,” European Urology 80, no. 6 (2021): 703–711, https://doi.org/10.1016/j.eururo.2021.07.024.
    1. H. U. Ahmed, A. El‐Shater Bosaily, L. C. Brown, et al., “Diagnostic Accuracy of Multi‐Parametric MRI and TRUS Biopsy in Prostate Cancer (PROMIS): A Paired Validating Confirmatory Study,” Lancet 389, no. 10071 (2017): 815–822, https://doi.org/10.1016/S0140-6736(16)32401-1.
    1. B. Turkbey, A. B. Rosenkrantz, M. A. Haider, et al., “Prostate Imaging Reporting and Data System Version 2.1: 2019 Update of Prostate Imaging Reporting and Data System Version 2,” European Urology 76, no. 3 (2019): 340–351, https://doi.org/10.1016/j.eururo.2019.02.033.
    1. N. J. Sathianathen, A. Omer, E. Harriss, et al., “Negative Predictive Value of Multiparametric Magnetic Resonance Imaging in the Detection of Clinically Significant Prostate Cancer in the Prostate Imaging Reporting and Data System Era: A Systematic Review and Meta‐Analysis,” European Urology 78, no. 3 (2020): 402–414, https://doi.org/10.1016/j.eururo.2020.03.048.
    1. EAU, EAU Guidelines, 2024, accessed October 16, 2024, https://uroweb.org/guidelines.

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