I'm amazed how often prostate size is known, and PSA density is never calculated or discussed even once. Patient subjected to numerous biopsies for PSA "spikes" that are perfectly explainable by a zero cost calculator test.
@CanesDavid 💯 Also, pts getting up-classified in risk just because a big prostate drives PSA up
PSA Density is way more predicative of clinically significant prostate cancer! Especially in the era of prostate MRI. Historically, the requirement for a DRE and less accuracy with a DRE volume was probably the main limiting factor for PSA density. But we don’t really have an excuse anymore!
@CanesDavid So many people have incidental imaging. It takes almost no time to pull up a CT scan, measure HxWxL and plug the numbers into the formula or use one of several free internet calculators. Every new elevated PSA or BPH consult gets that much from me if I can track down a scan.
@CanesDavid Some institutions are so oncologicaly focused they miss the forest for the trees. I have a few patients huge prostates elevated pvrs biopsies multiple times for bph psa variations never even put on an alpha blockers or had a clue poor urination can increase psa.
@CanesDavid Una mpMRI, aquí en México cuestan 250 dls y hasta pueden proyectar con exactitud y volumen a enuclear, forma, nódulos etc Y así probable se muestren menos ansiosos con el PSA
@CanesDavid On the flip side…. And often just as underutilized Is using PSA density for smaller prostates when a “borderline” PSA actually is very high i.e. PSA 3 in 25cc gland
@CanesDavid Sure. But then I think about the guy who I diagnosed 4+5 disease in a 85 gram prostate and a PSA of 4.2.
@CanesDavid One of the most beneficial and somewhat overlooked benefits of a prostate MRI
@CanesDavid It’s crazy that’s the case. The first thing I look at is PSA density before thinking about anything else.
@CanesDavid Is this something patients can proactively ask their doctors about? @CanesDavid
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