Prostate Specific Antigen Density as a Predictor for Prostate Cancer in Cases With Prostate Specific Antigen Levels Greater Than 4ng/Ml

Prostate cancer remains a signicant global health concern, with early detection essential for improved patient outcomes. While prostate-specic antigen (PSA) testing is widely used for screening, its specicity is limited, particularly for PSA levels exceeding 4 ng/mL. Prostate- specic antigen density (PSAD), which adjusts PSA values according to prostate volume, potentially offers greater diagnostic accuracy. This study aimed to evaluate the predictive value of PSAD in prostate cancer diagnosis and investigate its correlation with patient age, tumor aggressiveness, Gleason grade, and PIRADS scoring. A cross-sectional analytical study involving 229 men aged between 40 and 79 years with PSA levels above 4 ng/mL was conducted from March 2023 to February 2025. Participants underwent transrectal ultrasound (TRUS)-guided prostate biopsies, and the data were analyzed using IBM SPSS v26.0. The ndings revealed signicantly higher median PSAD values in prostate cancer patients (localized cancer: 0.39; metastatic cancer: 1.62) compared to those with benign conditions (BEP: 0.14; prostatitis: 0.21; p=0.001). PSAD demonstrated strong positive correlations with higher Gleason grades (Group 1: 0.18; Group 5: 1.0) and PIRADS scores (score 2: 0.14; score 5: 0.89; p=0.001), while no signicant association with patient age was observed (p=0.88). In conclusion, PSAD is a reliable, age-independent biomarker that enhances specicity in prostate cancer detection, predicts tumor aggressiveness, and informs clinical decision-making, particularly when combined with MRI ndings. Routine incorporation of PSAD into diagnostic protocols could signicantly reduce unnecessary biopsies and improve patient management.