PSA density

Last revised by Bálint Botz on 23 Jun 2022

The PSA density (PSAD), is a calculation performed at diagnosis and is the serum prostate specific antigen (PSA) level (ng/mL) divided by the volume of the prostate gland (mL), resulting in a value with the units, ng/mL2 1. Prostate volume is calculated from TRUS measurements 2,3

Alternatively, PSA density may be calculated using MRI measurements of prostate volumes or less commonly, using postsurgical histopathological measurements of prostate volumes 3,4.

PSA density has been used as a prognostication tool in helping decide between an active surveillance or an invasive approach when managing prostate carcinoma 5. The cut-off used most commonly is 0.15 or 0.20 ng/mL2

Practical points

Recent studies have shown that the most widely used thresholds have low detection rate, as threshold of 0.10 and 0.15 ng/mL2 resulted in the detection of only 77 and 49% of clinically significant (Gleason score ≥ 7) prostate cancers 6

Another recent study proposed stratification based on prior biopsy history for patients with elevated PSA level (>4 ng/mL) 7

  • no prior prostate biopsy: <0.10 ng/mL2
  • prior negative biopsy: <0.15 ng/mL2

See also

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Cases and figures

  • Case 1: PSA density of 0.06ng/ml
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