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PSA versus PSA density

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User
Posted 29 Nov 2019 at 10:59

I came across this paper which talks about PSA density:


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289697/


I’ve been assuming that my PSA (>300) is high, and therefore indicates a risk of spread.


However, dividing my PSA (I assume this is free PSA rather than bound or a ratio) by the estimated prostate volume from MRI gives a PSA density of 3.9. 


The oncology team at some point (and I had to ask a nurse to dig out the MDT report) changed my estimated gland volume to 70ml. Dividing the PSA by this new volume gives a PSA density of 4.5.


Which value (PSA, or PSA density) might provide the better indicator of future tumour progression, or is the difference irrelevant?


 

User
Posted 29 Nov 2019 at 13:15

My impression (which might be completely wrong) is that PSA density might have been more widely used when prostate imaging was mostly by ultrasound, and didn't give much more information than size of prostate. Now that mpMRI scanning is used, the scanning process bypasses the usefulness of PSA density, since it leaps directly to imaging the prostate cancer resulting in a PIRADS score, which is more useful than the PSA level once you get that far through the diagnosis.


Normal prostate size is usually quoted at 30cc, but "normal" is something of a misnomer. Many men's prostates start growing again from age 25, and prostates up to 4 times this are also relatively normal in older men, so your 70cc is not particularly remarkable. If we scale your PSA of 318 back to a 30cc prostate, it would become 136, but you already know it's not all coming from the prostate.

Edited by member 29 Nov 2019 at 13:17  | Reason: Not specified

User
Posted 29 Nov 2019 at 14:00

I’m no expert but I think free PSA ratio/ percentage, PSA density and PSA velocity combined are useful measurements to help predict future challenges.


 

Ido4

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User
Posted 29 Nov 2019 at 13:15

My impression (which might be completely wrong) is that PSA density might have been more widely used when prostate imaging was mostly by ultrasound, and didn't give much more information than size of prostate. Now that mpMRI scanning is used, the scanning process bypasses the usefulness of PSA density, since it leaps directly to imaging the prostate cancer resulting in a PIRADS score, which is more useful than the PSA level once you get that far through the diagnosis.


Normal prostate size is usually quoted at 30cc, but "normal" is something of a misnomer. Many men's prostates start growing again from age 25, and prostates up to 4 times this are also relatively normal in older men, so your 70cc is not particularly remarkable. If we scale your PSA of 318 back to a 30cc prostate, it would become 136, but you already know it's not all coming from the prostate.

Edited by member 29 Nov 2019 at 13:17  | Reason: Not specified

User
Posted 29 Nov 2019 at 14:00

I’m no expert but I think free PSA ratio/ percentage, PSA density and PSA velocity combined are useful measurements to help predict future challenges.


 

Ido4

User
Posted 08 Dec 2021 at 21:55

Sorry to hijack this post. I’ve been looking for information about PSA density, Free PSA and prostate gland volume but struggling with the search.


Is there anyone that could explain these to me and what is considered ‘normal’?


Thanks in advance


 

 
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