A PI-RADS 3 lesion means very different things at a PSA density of 0.08 and 0.25. Measure gland volume (ellipsoid or segmentation), divide the latest PSA by it, and state the result in the impression beside the PI-RADS score. Urologists use the pair to decide on biopsy, and today's German data show healthy men rarely exceed 0.11.
- Measure prostate volume on every MRI and state the method used.
- Calculate PSA density from the most recent PSA and put it in the impression.
- Pair PI-RADS 3 with PSA density when advising on biopsy.
- Note 5-alpha-reductase inhibitor use, which lowers PSA and so PSA density.
Why it matters
It turns an equivocal category into a clearer biopsy decision.
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