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Abstract

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 re-mains 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 to the lack of PSA specificity, there is still a disagreement about the effect of chronic and asympto-matic inflammation on total and free PSA values. Recent stud-ies suggest that subclinical inflammation seems to have signif-icant influence on free PSA in patients with total PSA levels up to 10 ng/ml. It is not characterized by elevated total PSA con-centrations alone but also by a decreased percentage of free PSA, a tendency similar to that in prostate cancer. Despite a significant effect of subclinical inflammation on PSA levels we cannot deduce whether the free PSA test is a reliable discrimi-nator between prostate cancer and prostatitis. However, when prostatic inflammation is identified, long term antibiotic or anti-inflammatory therapy seems to be a reasonable option. In this way a considerable number of patients would avoid unneces-sary prostate biopsies.
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