Reference values for PSA, PSA density, and MRI prostate volume in healthy German men

To establish stratified normative reference values for MRI-derived prostate volume (PV), prostate-specific antigen (PSA), and PSA density (PSAD) in German men with no known prostate pathologies, accounting for age, body-mass index, and height.

This study included men from the prospective population-based Study of Health in Pomerania, Germany, with 10 years of follow-up. Men with diagnosed prostate cancer, benign prostatic hyperplasia, or lower urinary tract symptoms were excluded to derive reference values unaffected by disease or interventions. PV and PSAD were obtained from pelvic MRI using deep-learning segmentation. In a test set, segmentation-derived volumes were compared with manual PVs. PV, PSA, and PSAD were modeled using generalized additive models for location, scale, and shape (GAMLSS).

Out of 1696 men, 1037 were analyzed (median age 46.00 years [IQR 38.00-56.00]). Median PV was 31.29 mL (5th-95th: 20.74-51.39), PSA 0.81 ng/mL (0.32-2.79), and PSAD 0.025 ng/mL² (0.011-0.071). PV and PSA increased progressively with age, whereas PSAD showed greater age-stability, peaking at 71 years, plateauing until 75, and then declining. Age-adjusted PSAD never exceeded 0.11 ng/mL², unlike PSA, which rose continuously. Body-mass index correlated positively with PV but inversely with PSAD; PSA showed a negative association with height.

This study provides reference values and percentile curves for PV, PSA, and PSAD in men without prostate disease, along with an open-access calculator. PSAD showed age-stability, contrasting with continuously rising PSA. These reference values may help distinguish normal from pathological prostatic variation across age strata and inform PSAD thresholds in screening programs.

Question Population-based reference values with long-term follow-up for PV, PSA, and PSAD are lacking, limiting the distinction between normal variation and disease-related changes. Findings Among 1037 men without prostate disease, 95th percentiles were: PV 51.39 mL, PSA 2.79 ng/mL, and PSAD 0.071 ng/mL². PSAD remained below 0.11 ng/mL² across all age ranges. Clinical relevance MRI-based percentiles for PV and PSAD may help identify normal variation, reducing unnecessary evaluations while supporting early detection of abnormalities. An open-access calculator enables personalized assessment for clinical and research purposes.