Purpose/Background Few studies have mapped prostate volume (PV) changes across the lifespan of asymptomatic patients. In this study we assessed PV changes with age in symptomatic and asymptomatic men with and without clinically significant prostate cancer (csPCa). In symptomatic patients, we additionally analysed the effect of age and csPCa on PSA and PSA-density (PSA-D) and compared these to current NICE-recommended PSA age-range thresholds. Methods This single-centre retrospective cross-sectional study included 2,512 men: 760 asymptomatic, disease-free men and 1,752 patients referred on a PCa diagnostic pathway. MRI-derived whole-gland PV was recorded for all patients. A machine-learning pipeline with k-fold cross validation modelled relationships between PV and age. Results In asymptomatic men (median PV 25.4ml), mean PV per age-group increased non-linearly with age, from 18.7ml at an increase of 0.10ml/year aged 18, to 41.3ml at 0.68ml/year aged 89, with increased rate of change from 48.9 years. Significant positive relationships were shown between PSA and age in patients with and without csPCa (r2=0.09 vs 0.13, respectively), with PSA increasing by mean 0.17ng/ml/year across groups. csPCa patients had consistently higher PSA levels. PSA-D showed significant age-related linear increases in csPCa, but remained consistently lower in those without csPCa at all ages (0.10-0.11 ng/ml2), allowing differentiation at a threshold of >0.15 ng/ml2. Conclusion In asymptomatic men, prostate volume changed non-linearly with age. Age-related PSA thresholds are supported, however, a static PSA-D threshold of 0.15 ng/ml2 can be applied across all age-ranges.
Rusbridge et al. (Thu,) studied this question.