Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer

Area of Science:

• Urology
• Oncology
• Medical Diagnostics

Background:

• Prostate-specific antigen (PSA) screening alone leads to overdiagnosis and unnecessary biopsies.
• PSA density (PSAd) is accessible but lacks guideline recommendations due to conflicting early evidence.

Purpose of the Study:

• To evaluate the utility of PSA density in predicting clinically significant prostate cancer (csPCa).
• To assess the impact of incorporating PSAd into biopsy decision-making.

Main Methods:

• Analysis of biopsy outcomes in 5291 men from the STHLM3 study with PSA ≥ 3 ng/ml.
• Calculation of PSA density (total PSA divided by prostate volume).
• Endpoint: clinically significant cancer (Gleason Score ≥ 7).

Main Results:

• PSA density was significantly associated with csPCa risk (OR 1.06-1.07).
• Adding PSAd improved model discrimination for csPCa (AUC 0.75 vs. 0.73).
• Omitting biopsies for PSAd ≤ 0.07 ng/ml² could reduce procedures by 19.7% while missing 6.9% of csPCa.

Conclusions:

• PSA density can inform prostate biopsy decisions.
• Utilizing PSAd may spare men from unnecessary biopsies and diagnosis of low-grade prostate cancer.