The influence of age and the presence of prostate cancer on prostate volume, PSA and PSA density

Objective To assess prostate volume (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 National Institute for Health and Care Excellence (NICE) recommended PSA age‐range thresholds. Patients and Methods This single‐centre retrospective cross‐sectional study included 2512 men: 760 asymptomatic, disease‐free men and 1752 patients referred on a PCa diagnostic pathway. Magnetic resonance imaging‐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 25.4 mL), the mean PV per age‐group increased non‐linearly with age, from 18.7 mL at an increase of 0.10 mL/year aged 18 years, to 41.3 mL at 0.68 mL/year aged 89 years, with increased rate of change from the age of 48.9 years. Significant positive relationships were shown between PSA and age in patients with and without csPCa ( r 2 = 0.09 vs 0.13, respectively), with PSA increasing by mean 0.17 ng/mL/year across groups. Patients with csPCa had consistently higher PSA levels. PSA‐D showed significant age‐related linear increases in patients with csPCa but remained consistently lower in those without csPCa at all ages (0.10–0.11 ng/mL 2 ), allowing differentiation at a threshold of >0.15 ng/mL 2 . Conclusion In asymptomatic men, PV changed non‐linearly with age. Age‐related PSA thresholds are supported; however, a static PSA‐D threshold of 0.15 ng/mL 2 can be applied across all age ranges.