title: Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels.
abstract: OBJECTIVE
  We quantify the causes of elevated serum prostate specific antigen (PSA) concentrations in men whose prostate biopsies repeatedly showed no cancer.
  
  
  METHODS
  The effects of prostate volume, inflammation, echogenicity on ultrasound and calculi were examined in a large PSA-based screening population of 148 men with serum PSA concentrations greater than 4.0 ng./ml., findings suspicious for cancer on digital rectal examination and multiple negative biopsies. These men were selected and compared to 64 men with suspicious rectal examinations, multiple negative biopsies and serum PSA concentrations of 4.0 ng./ml. or less.
  
  
  RESULTS
  The high PSA group had larger prostates (68 versus 33 cc, p = 0.0001) and significantly more subclinical prostatic inflammation. Acute and chronic inflammation was more prevalent in the high PSA group (63% versus 27%, p = 0.0001 and 99% versus 77%, p = 0.0001, respectively). A simultaneous regression analysis showed that prostatic size accounted for 23%, inflammation 7%, prostatic calculi 3% and nonisoechoic ultrasound lesions 1% of the serum PSA variance.
  
  
  CONCLUSIONS
  Prostate volume and inflammation are the most important factors contributing to serum PSA elevation in men without clinically detectable prostate cancer.
authors.affiliation: Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Nadler
authors.forename: P A
authors.initials: PA
authors.lastname: Humphrey
authors.forename: D S
authors.initials: DS
authors.lastname: Smith
authors.forename: W J
authors.initials: WJ
authors.lastname: Catalona
authors.forename: T L
authors.initials: TL
authors.lastname: Ratliff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D011472:Prostatitis / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen