Citation, DOI, disclosures and article data
Citation:
Bell D, Knipe H, Campos A, et al. PSA density. Reference article, Radiopaedia.org (Accessed on 20 May 2024) https://doi.org/10.53347/rID-59944
Disclosures:
At the time the article was last revised Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to
not be relevant to the changes that were made.
View Henry Knipe's current disclosures
The PSA density (PSAD) is calculated at diagnosis and is the serum prostate-specific antigen (PSA) level (ng/mL) divided by the prostate gland's volume (mL), resulting in a value in the units ng/mL2 1. Prostate volume is calculated from TRUS measurements, MRI measurements or, less commonly, resected pathological specimens 2-4.
PSA density has been used as a prognostication tool to help decide between active surveillance and an invasive approach when managing prostate carcinoma 5. The cut-off most commonly used is 0.15 or 0.20 ng/mL2.
Practical points
Studies have shown that the most widely used thresholds have low detection rates. The thresholds of 0.10 and 0.15 ng/mL2 detected only 77% and 49% of clinically significant prostate cancers 6.
Another study proposed stratification based on prior biopsy history for patients with an elevated PSA level (>4 ng/mL) 7:
It is important to remember that PSA density does not contribute to PI-RADS classification or TNM staging. It is also not an indicator of the likelihood of response to chemotherapy.
See also
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1. Andrew B. Rosenkrantz. MRI of the Prostate. (2017) ISBN: 9781626232686 - Google Books
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2.Mottet N, Bellmunt J, Briers E, van den Bergh R, Bolla M, van Casteren N, et al. Guidelines on Prostate Cancer. The Netherlands: European Association of Urology; 2015.
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3. Amiel G, Hollis M, Kreshover J, Terris M. Medical Student Curriculum: Prostate Cancer Screening and Management, Linthicum, MD: Americal Urological Association; 2016.
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4. Sfoungaristos S & Perimenis P. PSA Density is Superior Than PSA and Gleason Score for Adverse Pathologic Features Prediction in Patients with Clinically Localized Prostate Cancer. Can Urol Assoc J. 2012;6(1):46-50. doi:10.5489/cuaj.11079 - Pubmed
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5. Schoots IG, Osses DF, Drost FH, Verbeek JFM, Remmers S, van Leenders GJLH, Bangma CH, Roobol MJ. Reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSA-density, with different thresholds for significant disease. (2018) Translational andrology and urology. 7 (1): 132-144. doi:10.21037/tau.2017.12.29 - Pubmed
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6. Nordström T, Akre O, Aly M, Grönberg H, Eklund M. Prostate-Specific Antigen (PSA) Density in the Diagnostic Algorithm of Prostate Cancer. Prostate Cancer Prostatic Dis. 2018;21(1):57-63. doi:10.1038/s41391-017-0024-7 - Pubmed
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7. Bruno S, Falagario U, d'Altilia N et al. PSA Density Help to Identify Patients With Elevated PSA Due to Prostate Cancer Rather Than Intraprostatic Inflammation: A Prospective Single Center Study. Front Oncol. 2021;11:693684. doi:10.3389/fonc.2021.693684 - Pubmed
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