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Men with diagnosed prostate cancer, benign prostatic hyperplasia, or lower urinary tract symptoms were excluded to derive reference values unaffected by disease or interventions. PV and PSAD were obtained from pelvic MRI using deep-learning segmentation. In a test set, segmentation-derived volumes were compared with manual PVs. PV, PSA, and PSAD were modeled using generalized additive models for location, scale, and shape (GAMLSS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 1696 men, 1037 were analyzed (median age 46.00 years [IQR 38.00\u201356.00]). Median PV was 31.29\u2009mL (5th\u201395th: 20.74\u201351.39), PSA 0.81\u2009ng\/mL (0.32\u20132.79), and PSAD 0.025\u2009ng\/mL\u00b2 (0.011\u20130.071). PV and PSA increased progressively with age, whereas PSAD showed greater age-stability, peaking at 71 years, plateauing until 75, and then declining. Age-adjusted PSAD never exceeded 0.11\u2009ng\/mL\u00b2, unlike PSA, which rose continuously. Body-mass index correlated positively with PV but inversely with PSAD; PSA showed a negative association with height.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides reference values and percentile curves for PV, PSA, and PSAD in men without prostate disease, along with an open-access calculator. PSAD showed age-stability, contrasting with continuously rising PSA. These reference values may help distinguish normal from pathological prostatic variation across age strata and inform PSAD thresholds in screening programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Population-based reference values with long-term follow-up for PV, PSA, and PSAD are lacking, limiting the distinction between normal variation and disease-related changes<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Among 1037 men without prostate disease, 95th percentiles were: PV 51.39\u2009mL, PSA 2.79\u2009ng\/mL, and PSAD 0.071\u2009ng\/mL\u00b2. PSAD remained below 0.11\u2009ng\/mL\u00b2 across all age ranges<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>MRI-based percentiles for PV and PSAD may help identify normal variation, reducing unnecessary evaluations while supporting early detection of abnormalities. An open-access calculator enables personalized assessment for clinical and research purposes<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12937-2","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T08:15:54Z","timestamp":1790324154000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reference values for PSA, PSA density, and MRI prostate volume in healthy German men"],"prefix":"10.1007","author":[{"given":"Maximilian","family":"Lindholz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo G.","family":"Schoots","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"B\u00fclow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Asbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"K\u00f6lln","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"Nolte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salina","family":"Alaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Ruppel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Hosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Penzkofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4104-4758","authenticated-orcid":false,"given":"Charlie A.","family":"Hamm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"12937_CR1","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1016\/j.juro.2009.06.047","volume":"182","author":"S Loeb","year":"2009","unstructured":"Loeb S, Kettermann A, Carter HB, Ferrucci L, Metter EJ, Walsh PC (2009) Prostate volume changes over time: results from the Baltimore Longitudinal Study of Aging. 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C.A.H. receives funding from the Berlin Institute of Health (Digital Clinician Scientist Grant) and Siemens Healthineers and previously received seed funding from the University Medicine Greifswald, personal fees from Siemens Healthineers, Bayer AG, Koelis AG, Bracco Imaging Deutschland, and Lucida Medical, and a grant from the Ministry of Education and Research (01KX2524 [NUM 3.0]) outside the submitted work. P.A. receives funding from the German Research Foundation (DFG, SFB 1340-1\/2) and consultant fees from the Professional Association of the German Radiologist (BDR e.V.). T.P. receives funding from the Berlin Institute of Health (Advanced Clinician Scientist Grant, Platform Grant), the Federal Ministry of Education and Research (BMBF, 01KX2121, 68GX21001A, 01ZZ2315D), the German Research Foundation (DFG, SFB 1340\/2), and the European Union (H2020 CHAIMELEON: 952172; EUCAIM: 101100633). T.P. additionally declares research agreements (no personal payments) with multiple companies including Siemens Healthineers, Roche, AstraZeneca, Merck Sharp & Dohme, and others, as well as speaking fees from Bayer Healthcare. No other disclosures were reported.\u00a0Prof. Bernd Hamm, the Editor-in-Chief of\n                      European Radiology\n                      , had no role in handling this manuscript and finalizing decisions.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Maximilian Lindholz has significant statistical expertise (MSc).","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"This study analyzed data from the ongoing, prospective, government-funded, population-based SHIP and was approved by the Ethics Committee at the University Medicine Greifswald (approval numbers BB122\/13 and BB39\/08).","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Some study subjects or cohorts have been previously reported in Lindholz et al [\n                      \n                      ].","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}