PSA Density: Reliable Predictor for Prostate Cancer Detection in BPH Patients with Negative MRI Findings, Study Finds

"A PSAD threshold of 0.30 ng/ml/cm³ demonstrated superior accuracy in guiding biopsy decisions compared to total PSA and the F/T PSA ratio. Incorporating PSAD into clinical practice could help minimize unnecessary biopsies, reduce hospital stays, and lower complication risks, leading to better patient management," the researchers reported.

The researchers note that for men with benign prostatic hyperplasia and surgical indications, elevated PSA levels often raise concerns about potential prostate cancer, leading to the recommendation of a biopsy. However, MRI-negative findings introduce uncertainty, making it challenging to determine whether a biopsy is necessary. Therefore, Wenhao Shen, Army Medical University, (Third Military Medical University), Shapingba District, Chongqing, China, and colleagues aimed to establish an effective clinical parameter or model for guiding prostate biopsy decisions in patients with BPH requiring surgery who present with elevated PSA levels and negative multiparametric prostate MRI findings.

For this purpose, the researchers retrospectively analyzed clinical and pathological data of BPH patients admitted for surgery between January 2010 and September 2020. Key clinical parameters, including age, PSA level, F/T PSA ratio, prostate volume, and PSA density, were evaluated. Univariate and multivariate logistic regression analyses were conducted to develop a predictive model. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) assessed the diagnostic accuracy of the predictive model, PSA concentration, F/T PSA ratio, and PSAD.

Based on the study, the researchers reported the following findings:

• The study included 318 patients, with 8.2% (26/318) diagnosed with prostate cancer (PCa) through biopsy.
• Analysis showed that PSA density was the only independent predictor of PCa in biopsy decisions.
• ROC curve analysis indicated that PSAD (AUC 0.848) and the predictive model (AUC 0.855) had higher accuracy than PSA (AUC 0.722) or the F/T PSA ratio (AUC 0.635) in detecting PCa.
• Decision curve analysis (DCA) suggested that limiting biopsies to patients with a PSAD of 0.30 ng/ml/cm³ would be the most effective approach.

The researchers suggested that for BPH patients requiring surgery who have PSA abnormalities but negative imaging findings, a PSAD threshold of 0.30 ng/ml/cm³ could be a valuable tool for making personalized biopsy decisions.

"Our findings highlight that this approach may help minimize unnecessary biopsies, lower complications, shorten hospital stays, and reduce overall healthcare costs," they concluded.

Reference:

Peng, Y., Wei, C., Li, Y. et al. Optimal PSA density threshold for prostate biopsy in benign prostatic obstruction patients with elevated PSA levels but negative MRI findings. BMC Urol 25, 42 (2025). https://doi.org/10.1186/s12894-025-01719-5