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Prostate-specific antigen (PSA) is indispensable but not cancer specific; inflammation, benign prostatic hyperplasia, urinary retention, ejaculation, and instrumentation can all elevate PSA and complicate cancer risk assessment. This review synthesizes current evidence and guidelines to support clinicians in interpreting PSA elevations when inflammation is present or suspected. Acute febrile urinary tract infection and acute bacterial prostatitis may produce very high PSA values, sometimes exceeding 100 ng/mL, and normalization can be slow; therefore, PSA testing during active infection is discouraged. When PSA is only mildly to moderately elevated, standardized repeat testing is essential because a meaningful proportion of results normalize on retesting. A magnetic resonance imaging (MRI)-first pathway improves detection of clinically significant prostate cancer while reducing overdiagnosis and enables biopsy deferral after a negative MRI under structured monitoring.

PSA density (PSAD) further refines triage alongside MRI, with practical working thresholds of roughly 0.10–0.20 ng/mL/cm3 calibrated to MRI quality and pretest risk. However, asymptomatic histologic prostatitis (National Institutes of Health category IV) is common and may raise PSA without reliably altering PSAD, which means that PSAD alone cannot confirm that an elevation is attributable solely to inflammation. Validated secondary biomarkers (e.g., Prostate Health Index, 4Kscore, IsoPSA [isoform PSA], Stockholm3, Proclarix, PCA3 [prostate cancer gene 3], SelectMDx [select molecular diagnostics], ExoDx [exosome diagnostics], MPS/MPS2 [MyProstateScore/MyProstateScore 2.0]) are best used selectively when MRI is negative or equivocal and clinical risk remains uncertain.

A pragmatic sequence—confirm, image, and refine—helps minimize missed clinically significant cancer while reducing unnecessary antibiotics and biopsies when inflammation is the predominant driver of PSA elevation.

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기사명 저자명 페이지 원문 목차
Adult syphilis : a narrative review of clinical insights and public health implications in urology Seung-Ju Lee, Jin Bong Choi p. 123-131
Beyond the number : interpreting prostate-specific antigen elevation in the context of prostate inflammation Byoungkyu Han, Ki-Hyuck Moon p. 132-143
Regenerative medicine for the kidney Vladimir Mashanov, Ji Hyun Kim p. 144-158
Clinical characteristics and risk factors of Fournier gangrene : a 15-years multicenter retrospective study in Korea Seung-Kwon Choi, Sin Woo Lee, Hyung-Lae Lee, Jeong Woo Lee, Jung Sik Huh, Yeonjoo Kim, Sangrak Bae, Tae-Hyoung Kim p. 159-166
Primary bladder and ureteral amyloidosis initially diagnosed as chronic cystitis : a case report Seungsoo Lee, Dan Bee Lee, Hyun Jung Lee, Won Hoon Song, Sung-Woo Park, Jong Kil Nam p. 167-172

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