The effects of prostate volume and PI-RADS category on optimal PSA-density thresholds for biopsy decision-making
Question The optimal PSA-density thresholds for biopsy decisions in PI-RADS 1-3 patients remain uncertain, and data on the impact of prostate volume on its performance are limited. Findings Optimal PSA-density thresholds were 0.20 ng/mL² for PI-RADS 1-2 and 0.12 ng/mL² for PI-RADS 3. Diagnostic performance of PSA-density decreased significantly in men with larger glands (≥ 60 mL). Clinical relevance PSA-density cut-offs of 0.20 (PI-RADS 1-2) and 0.12 ng/mL² (PI-RADS 3) can guide biopsy decisions. In PI-RADS 1-3 patients with large prostate (≥ 60 mL), PSA-density becomes significantly less predictive, and low values may not reliably exclude csPCa.
Authors
- Kang-Lung Lee
- Selahattin Durmaz (ORCID: https://orcid.org/0000-0002-2456-9483)
- Tristan Barrett (ORCID: https://orcid.org/0000-0002-1180-1474)
- Shun-Chin Jim Wu (ORCID: https://orcid.org/0000-0001-6895-0334)
- Amreen Shakur
- Iztok Caglič (ORCID: https://orcid.org/0000-0002-3432-3540)
Institutions
- National Yang Ming Chiao Tung University (TW)
- University of Cambridge (GB)
- Cambridge University Hospitals NHS Foundation Trust (GB)
- Taipei Veterans General Hospital (TW)
- Gaziosmanpaşa Taksim Eğitim ve Araştırma Hastanesi (TR)
- Addenbrooke's Hospital (GB)
- University College London (GB)
Publication Details
- Journal
- European Radiology
- Published
- 2026-01-04
- DOI
- https://doi.org/10.1007/s00330-025-12272-y
- Primary Topic
- Prostate Cancer Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Cancer Research UK
- Engineering and Physical Sciences Research Council
- NIHR Cambridge Biomedical Research Centre