Markers of a prostate size greater than 30 g

Measurement method	Advantages	Limitations
Serum PSA greater than 1.5 ng/mL	Noninvasive	Serum PSA ranges vary based on age, may be elevated if prostate cancer is present, and may be suppressed if the patient is taking a 5-ARI
Enlarged gland on DRE	Simple, cost effective	DRE is the least accurate method for estimating prostate size
TRUS	May be performed in urology clinic	Invasive, requires urologist evaluation
MRI	Most accurate method	Imaging should not be pursued solely for prostate size estimation due to cost; CT also carries the risk of excess radiation exposure
CT	No specific advantages for evaluating the prostate but may be an incidental finding when CT is obtained for another indication

When prostate gland size is estimated to be greater than 30 g, treatment with a 5-ARI is indicated. The accepted markers for a prostate gland greater than 30 g are presented above; each has its own advantages and limitations. While imaging provides the most accurate estimate of prostate size, we discourage ordering imaging solely to determine medical therapy. Rather, recent imaging results performed for other indications may be repurposed to estimate prostate size. Please refer to related UpToDate content for further detail.

5-ARI: 5-alpha-reductase inhibitor; CT: computed tomography; DRE: digital rectal examination; MRI: magnetic resonance imaging; ng: nanograms; PSA: prostate-specific antigen; TRUS: transrectal ultrasound.

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Markers of a prostate size greater than 30 g