Is chronic inflammatory change in the prostate the major cause of rising serum prostate-specific antigen in patients with clinical suspicion of prostate cancer?

Aim: To evaluate the cause of elevated prostate-specific antigen (PSA) in patients with transrectal needle biopsy negative for prostate cancer.

Methods: Serum PSA concentration, prostate volume, and pathologic findings were examined in 223 patients with negative biopsy for prostate cancer. The degree of prostate inflammation was determined by the extent and degree of inflammation shown by biopsy specimens and is expressed as an inflammation score (range: 0–36).

Results: A significant correlation was found between PSA concentration and prostate total volume (P = 0.0001). Prostate chronic inflammation showed no correlation with PSA concentration (P = 0.485, F = 0.488). After allocating patients to normal PSA (≤4 ng/mL) and high PSA (>4 ng/mL) groups, we found that serum PSA concentrations in both groups were predominantly affected by prostate total volume.

Conclusions: An increase in prostate volume appears to be the major contributor to a high serum PSA concentration in patients with negative biopsy for prostate cancer. However, in contrast to previous reports, there was no correlation between the degree of prostate chronic inflammation and serum PSA concentrations.