The role of prostate-specific antigen in the evaluation of benign prostatic hyperplasia

This article reviews the role of prostate-specific antigen (PSA) in the evaluation of BPH. Efficacy of the PSA test in differentiating patients with BPH from patients with early, potentially curable prostate cancer is discussed. In addition, this complete overview provides a critical analysis of various concepts (PSA density, PSA velocity, age-specific reference ranges, and free versus complexed serum PSA), that are devised to optimize the diagnostic value of the serum PSA concentration in a population in which prostate cancer and BPH are almost equally prevalent. A clinical algorithm, useful to the practicing clinician for the early detection of prostate cancer in the BPH patient, is also proposed.