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. 2025 Jul 17;43(1):445.
doi: 10.1007/s00345-025-05814-y.

PSA density correlates to pathology T stage and ISUP grade: insights from a cohort of 3568 radical prostatectomy cases

Maxime Pattou  1 , Yann Neuzillet  2 , Tarek Ghoneim  2 , Pierre-Olivier Bosset  2 , Jean-Marie Herve  2 , Victor Vanalderwerelt  2 , Denis Bohin  2 , Pierre-Marie Lugagne  2 , Yanish Soorojebally  2 , Thierry Lebret  2
Affiliations

PSA density correlates to pathology T stage and ISUP grade: insights from a cohort of 3568 radical prostatectomy cases

Maxime Pattou et al. World J Urol. .

Abstract

Introduction: Prostate-specific antigen density (PSAD) is a valuable detection tool for prostate cancer (PCa) with PSA levels in the "gray zone" (4-10 ng/mL). However, its relationship with final pathology outcomes remains limited, especially on large cohorts.

Objective: This study aimed to describe PSAD distributions according to final pathology findings (pathological T stage and ISUP grade) and identify clinical and pathological factors influencing PSAD variations.

Methods: We analyzed a prospective cohort of 3568 patients who underwent radical prostatectomy for PCa in our center between 2007 and 2025. PSAD was calculated using serum PSA (ng/mL) divided by prostate weight (g) from pathology reports. Associations between PSAD and pathology T stage, ISUP grade, total testosterone, cholesterol levels, and statin use were done using Spearman's correlation coefficient, stratified rank ANCOVA analysis and a multiple linear regression.

Results: The median PSAD was 0.17 ng/mL/g (IQR: 0.12-0.25). PSAD levels increased gradually with advanced pathology T stage (pT3a and T3b) and higher ISUP grade (p < 0.001 for both). After adjusting for confounding covariates (age and D'Amico risk classification), PSAD remained significantly associated with Pathology T stage and ISUP. Within the high-risk category, high biopsy ISUP and pathology ISUP grades were associated with lower PSAD levels (r = -0.59 and - 0.49 respectively). PSAD levels were associated with four adverse pathology outcomes, namely positive surgical margins, nodal involvement, ISUP ≥ 4 upgrading and pT ≥ 3 upstaging. Multivariate analysis identified higher biopsy ISUP grade and PSA levels as positive predictors of PSAD, while age, BMI, and testosterone were negatively associated.

Conclusion: PSAD correlates with PCa aggressiveness on pathology, making it a clinically relevant biomarker. Future studies should investigate PSAD's relation with adverse oncological outcomes, including biochemical recurrence.

Keywords: Biomarkers; ISUP grade; PSA density; Pathological staging; Prostate cancer; Radical prostatectomy; Risk stratification.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: All patients gave informed consent, the study was approved by the Foch hospital ethics committee (IRB00012437). The study was conducted in accordance with the Declaration of Helsinki.

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References

    1. Jue JS et al (2017) Re-examining prostate-specific antigen (PSA) density: defining the optimal PSA range and patients for using PSA density to predict prostate cancer using extended template biopsy. Urology 105:123–128. https://doi.org/10.1016/j.urology.2017.04.015 - DOI - PubMed
    1. Catalona WJ et al (2000) Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. Urology 56(2):255–260. https://doi.org/10.1016/S0090-4295(00)00637-3 - DOI - PubMed
    1. Al-Khalil S, Ibilibor C, Cammack J, De Riese W (2016) Association of prostate volume with incidence and aggressiveness of prostate cancer. RRU 8:201–205. https://doi.org/10.2147/RRU.S117963 - DOI
    1. Rogosin S et al (2007) PSA density as a predictor of aggressive prostate cancer on repeat prostate biopsy. JCO 25(18):5007–5007. https://doi.org/10.1200/jco.2007.25.18_suppl.5007 - DOI
    1. Wang S et al (2024) Diagnostic performance of prostate-specific antigen density for detecting clinically significant prostate cancer in the era of magnetic resonance imaging: a systematic review and meta-analysis. Eur Urol Oncol 7(2):189–203. https://doi.org/10.1016/j.euo.2023.08.002 - DOI - PubMed

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