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Prostatitis and early detection of prostate cancer

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Prostate-specific antigen (PSA) is the most useful marker for the early detection and follow up of patients with prostate cancer. However, PSA is not a cancer-specific marker and elevated PSA levels due to benign conditions most directly underscore the difficulty in making a decision about the need for prostate biopsy. Today, an important question remains as to the nature of the relationship between PSA and chronic prostatic inflammation. Inflammation is a frequent pathological finding in prostate biopsies, performed on men without prostatic malignancy. Although it is known that acute inflammation can contribute on lack of PSA specificity, there is still a disagreement in the effect of chronic and asymptomatic inflammation on total anf free PSA values. Recent studies suggest that subclinical inflammation seems to have significant influence on free PSA in patients with total PSA levels up to 10 ng/ml. It is not characterized by elevated total PSA concentrations alone but also by a decreased percentage of free PSA, a tendency similar to that in prostate cancer. Despite significant effect of subclinical inflammation on PSA levels we cannot deduce if the free PSA is a reliable discriminator between prostate cancer and prostatitis. However, when prostatic inflammation is identified, long term antibiotic or anti-inflammatory therapy seems like a reasonable option. In this way a considerable number of patients would avoid unnecessary prostate biopsies.
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