Elevated serum prostate specific antigen (PSA) related to asymptomatic prostatic inflammation

Prostatic subclinical inflammation is associated with elevated serum prostate specific antigen (PSA) level when there is contact with and disruption of the glandular epithelium of the prostate. This aggressiveness of the inflammation was graded on a 4-point scale proposed by Irani (1). Patients with an elevated serum PSA level and no malignancy in their transrectal prostate biopsy, have a lower risk of biopsy missed prostate carcinoma when there is an inflammation with a high aggressiveness score. The density itself of the inflammatory cells in the prostatic tissue was not associated with the serum PSA level. We believe that both issues should be considered when interpreting a prostate biopsy.