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The following is a summary of “Optimal PSA density threshold for prostate biopsy in benign prostatic obstruction patients with elevated PSA levels but negative MRI findings,” published in the March 2025 issue of BMC Urology by Peng et al. 

Researchers conducted a retrospective study to identify a clinical parameter for prostate biopsy in patients with benign prostate hyperplasia (BPH) and surgical indications, elevated prostate specific antigen (PSA), and negative magnetic resonance imaging (MRI) results.  

They analyzed clinical and pathological data from patients with BPH admitted for surgery between January 2010 and September 2020 and used clinical data, including age, PSA level, F/T PSA ratio, prostate volume, and PSA density (PSAD), for comprehensive analysis. A univariate and multivariate logistic regression was performed to develop a predictive model. Receiver operating characteristic (ROC) and decision curve analysis (DCA) analyses assessed the diagnostic value of the model, PSA concentration, F/T PSA ratio, and PSAD. 

The results showed that 8.2% (26/318) of patients had prostate cancer (PCa), with PSAD as the only independent predictor, ROC analysis showed higher area under the curve (AUC) for the predictive model (0.855) and PSAD (0.848) than PSA (0.722) or F/T PSA ratio (0.635). The DCA indicated restricting biopsies to those with PSAD ≥0.30 ng/ml/cm³ as the optimal strategy.  

They found that a PSAD threshold of 0.30 ng/ml/cm³ helped guide biopsy decisions in patients with BPH and PSA abnormalities, negative imaging, reducing complications, hospital stay, and costs.  

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-025-01719-5