# PSA Density Calculator for Prostate Tumor Volume and Density

Determines prostate tumor volume and density to help with differential diagnosis between benign prostatic hyperplasia (BPH) and prostate cancer.

PSAD is used as prognostication tool in the prostate cancer diagnosis protocol and is obtained by dividing the serum prostate-specific antigen (PSA) by the volume of the prostate obtained following ultrasound measurement.

PSA density helps distinguish between Benign prostatic hyperplasia (BPH) and prostate cancer.

The density cut-off of 0.15-0.20 ng/mL/cc is used to help guide clinical decision between a watch-and-wait or an invasive approach when managing prostate carcinoma.

• `Prostate Volume in cc = L x W x H x π/6`
• `Prostate Density in ng/mL/cc = PSA / Volume`

Prostate Length
Prostate Width
Prostate Height
Prostate-Specific Antigen (PSA) Value
Embed  Print  Share

Steps on how to print your input & results:

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

## PSA Density Explained

PSAD is used as prognostication tool in the prostate cancer diagnosis protocol and is obtained by dividing the serum prostate-specific antigen (PSA) by the volume of the prostate obtained following ultrasound measurement.

• `Prostate Volume in cc = L x W x H x π/6`
• `Prostate Density in ng/mL/cc = PSA / Volume`

PSA density helps distinguish between Benign prostatic hyperplasia (BPH) and prostate cancer. The cut-off of 0.15-0.20 ng/mL/cc is used to help guide clinical decision between a watch-and-wait or an invasive approach when managing prostate carcinoma.

Next step: Use the above in association with the Gleason Score, to prognosticate prostate cancer recurrence.

The prostate-specific antigen is a protein formed by both normal and cancer prostatic cells, usually found in semen but also in blood, in smaller quantities. The higher the serum PSA (whilst there isn’t a set cut-off, 4 ng/mL is commonly used), the greater the likelihood of positive prostatic cancer diagnosis so this PSA level is used as indication for further testing.

But it was also found that about 15% of men with PSA below 4 may have prostate cancer, if biopsy performed. At PSA levels between 4 and 10 ng/mL (the borderline range), there is a 25% chance of cancer which increases to over 50% for PSA above 10 ng/mL.

Potential causes for abnormally raised or lowered PSA levels are summarized in the table below:

 Raised PSA levels Lowered PSA levels Benign prostatic hyperplasia (BPH) 5-alpha reductase inhibitors Older age Some herbal supplements (e.g. saw palmetto) Prostatitis Some medicines (e.g. aspirin, statins, thiazide diuretics) Certain urologic procedures Hormonal therapy with testosterone

Several studies have looked at the predictive properties of PSAD to help guide clinical decision making if biopsy is required or not. In a study by Jue et al. PSA density performed better than PSA alone above 4 ng/mL for detecting prostate cancer.

In a 2018 study by Nordström et al. 5,291 men in a population with PSA levels of 3 ng/mL or greater and ultrasound-guided prostate volume measurements, PSAD results were calculated. Main endpoint was clinically significant cancer defined as a Gleason Score of 7 or greater.

The median PSA-density was 0.10 ng/ml2. Discrimination for clinically significant cancer was better when PSA density was added to a model with additional clinical information (AUC 0.75 vs. 0.73, P < 0.05).

## References

### Original reference

Vollmer RT, et. al. Tumor Volume in Prostate Cancer and Serum Prostate-Specific Antigen. Analysis From a Kinetic Viewpoint. Am J Clin Pathol 2003; 119:80-89.

### Other references

Jue JS, Barboza MP, Prakash NS, et al. Re-examining Prostate-specific Antigen (PSA) Density: Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy. Urology. 2017; 105:123-128.

Nordström T, Akre O, Aly M, Grönberg H, Eklund M. Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer. Prostate Cancer Prostatic Dis. 2018; 21(1):57-63.

Nordström T, Adolfsson J, Grönberg H, Eklund M. Effects of increasing the PSA cutoff to perform additional biomarker tests before prostate biopsy. BMC Urol. 2017; 17(1):92.

Catalona WJ. Clinical utility of measurements of free and total prostate-specific antigen (PSA): a review. Prostate Suppl. 1996; 7:64-69.

Specialty: Urology

Year Of Study: 2003

Article By: Denise Nedea

Published On: June 26, 2020

Last Checked: June 26, 2020

Next Review: June 26, 2025