The Shortcomings of PSA Density

Calculating PSA density can help your healthcare provider analyze your prostate-specific antigen (PSA) score and determine whether or not your results are abnormal. PSA is produced by prostate cells—whether the cells are normal or cancerous. Men with larger prostates, logically, have more prostate cells and, in general, produce more PSA regardless of whether they have cancer or not. So your PSA score alone can't be used to determine whether or not you have prostate cancer.

To account for different prostate sizes, your prostate’s volume is measured via transrectal prostate ultrasound. Your PSA level is then divided by the size of your prostate to calculate your PSA density.

A high PSA density means that a relatively small volume of prostate tissue is making a lot of PSA, while a low PSA density means that a large volume of prostate tissue is making relatively little PSA.

Prostate model / Getty Images

Shortcomings of Absolute PSA

In the past, healthcare providers relied heavily on the absolute PSA level to help determine whether or not your prostate cancer had been eliminated as well as if returned after treatment, how extensive the disease was, and other factors.

However, it became apparent that just looking at the absolute PSA level failed in some important ways. For one, some men with normal or even low absolute PSA levels have been found to have prostate cancer. Second, many men with very high absolute PSA levels do not have prostate cancer and, have instead, a benign, less dangerous condition known as benign prostatic hyperplasia (BPH).

Your absolute PSA level will not always tell the whole story. That is why healthcare providers began using other PSA values such as PSA velocity, PSA density, and percent-free PSA, to get a more accurate idea of what's happening in the prostate.

Does Your PSA Density Actually Matter?

On one hand, a high PSA density could indicate you have a higher risk of prostate cancer. However, the evidence for this likely higher risk of prostate cancer does not really change your diagnosis or treatment if you have a high PSA density.

Not all experts agree that PSA density should change the way your practitioner diagnoses, monitors, or treats prostate cancer. Some healthcare providers feel that PSA density is simply not helpful when making decisions and choose to ignore it.

If you're worried about your PSA density, discuss your concerns with your practitioner or see a different healthcare provider for a second opinion. If you're unsure about your practitioner's views on PSA density or levels generally, ask them to share their understanding of the issue and if their views on the matter change how they treat their patients.

Overall, men with a higher PSA density should be more vigilantly monitored for prostate cancer. If you have a higher PSA density, your healthcare provider may be more suspicious about any abnormalities found on your digital rectal exam or if your PSA level increases.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gjertson CK, Albertsen PC. Use and assessment of PSA in prostate cancer. Med Clin North Am. 2011;95(1):191-200. doi:10.1016/j.mcna.2010.08.024

  2. Kehinde EO, Sheikh M, Mojimoniyi OA, et al. High serum prostate-specific antigen levels in the absence of prostate cancer in Middle-Eastern men: the clinician's dilemma. BJU Int. 2003;91(7):618-22. doi:10.1046/j.1464-410x.2003.04199.x

  3. Adhyam M, Gupta AK. A review on the clinical utility of PSA in cancer prostate. Indian J Surg Oncol. 2012;3(2):120-9. doi:10.1007/s13193-012-0142-6

  4. Faisal FA, Sundi D, Pierorazio PM, et al. Outcomes of men with an elevated prostate-specific antigen (PSA) level as their sole preoperative intermediate- or high-risk feature. BJU Int. 2014;114(6b):E120-E129. doi:10.1111/bju.12771

  5. Jean-Pierre G. Advice about screening for prostate cancer with prostate-specific antigen. J Adv Pract Oncol. 2017;8(6):639-645.

By Matthew Schmitz, MD
Matthew Schmitz, MD, is a professional radiologist who has worked extensively with prostate cancer patients and their families.