Volume 30, Issue 168, February 2026

The role of prostate-specific antigen density (PSAD) in prostate cancer diagnostics: a literature review with cut-off thresholds and integration with multiparametric magnetic resonance imaging

Mateusz Mazurek^1♦, Zuzanna Czuba¹, Maciej Świerczyna⁴, Agata Olecka³, Filip Gałązka², Fryderyka Orawczak⁵, Jakub Majcherek⁶, Julia Gałązka⁷, Mikołaj Kotusiewicz⁹, Tomasz Karwowski⁸

¹Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
²Copernicus PL Sp. z o.o., St. Adalbert Hospital, aleja Jana Pawła II 50, 80-462 Gdańsk, Poland
³7th Military Naval Hospital, Polanki 117, 80-305 Gdańsk, Poland
⁴Ministry of the Interior and Administration Hospital, Północna 42, 91-425 Łódź, Poland
⁵Medical University of Lodz, Al. Kosciuszki 4, 90-419, Lodz, Poland
⁶Voivodeship Hospital in Tarnów, Lwowska 178A, 33-100, Tarnów, Poland
⁷Cardinal Stefan Wyszyński University in Warsaw, Wóycickiego 1/3, 01-938 Warsaw, Poland
⁸Voivodeship Hospital in Płock, Medyczna 19, 09-400 Płock, Poland
⁹Jagiellonian University: Krakow, Lesser Poland

^♦Corresponding author
Mateusz Mazurek, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland

ABSTRACT

Prostate-specific antigen density (PSAD) is a clinical parameter with diagnostic value in urology. Normalizing PSA concentrations to prostatic volume enables PSAD assessment, providing information beyond that obtainable with total PSA alone, thereby improving specificity and decreasing unnecessary biopsies. The value of 0.15–0.20 ng/mL/cm³ is widely used to limit the risk of significant cancers while avoiding the pitfalls of over-detection. The use of PSAD is considered to have specific diagnostic utility in cases with ambiguous multiparametric magnetic resonance imaging (mpMRI) results, particularly for lesions classified as Pi-RADS score 3. In these conditions, it has repeatedly been shown that imaging may not be sufficient for distinguishing between incurable and clinically relevant prostate cancers. Precise prostate volume measurement is critical because the technique used, such as MRI, transrectal ultrasound (TRUS), or transabdominal ultrasound (TAUS), affects the level of accuracy in subsequent PSAD calculation. It is imperative to note that recent developments in artificial intelligence/machine learning may help improve the reproducibility and standardization of prostate volume measurement. In conclusion, PSAD is an interesting and generally applicable biomarker that improves risk assessment and, above all, biopsy decisionmaking, especially in the assessment of the borderline prostate. However, there is still a need for province-specific guidelines and further prospective studies regarding the use of PSAD.

Keywords: prostate cancer (PCa); prostate-specific antigen (PSA); prostate-specific antigen density (PSAD); multiparametric magnetic resonance imaging (mpMRI); prostate biopsy.

Medical Science, 2026, 30, e40ms3748

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DOI: https://doi.org/10.54905/disssi.v30i168.e40ms3748

Published: 23 February 2026