Review article
The PSA Test: Where Does Benign Hyperplasia End and Cancer Begin?
Tomislav Kuliš
Abstract
Prostate-specific antigen (PSA) is a key biomarker in the diagnosis and monitoring of prostate diseases. Although not specific exclusively for prostate cancer, its introduction revolutionized early detection of the disease in the late 20th century. Elevated PSA levels may result from benign prostatic hyperplasia, inflammation, or medical interventions, which reduce its specificity and increase the number of unnecessary biopsies. To improve differentiation between benign and malignant conditions, additional parameters have been introduced, such as PSA density (PSAD), free-to-total PSA ratio (f/t PSA), and PSA velocity (PSAV). Multiparametric magnetic resonance imaging (mpMRI) plays a particularly important role in modern diagnostics, enabling accurate detection of clinically significant prostate cancer and reducing the number of unnecessary biopsies, while micro-ultrasound represents a novel, accessible alternative with comparable diagnostic value. Prostate biopsy, especially when targeted and guided by mpMRI or micro-ultrasound, remains the gold standard for confirming the diagnosis. The combination of PSA parameters, imaging methods, and targeted biopsy improves diagnostic accuracy, reduces overdiagnosis, and supports an individualized approach to treatment. Future research is focused on the development of novel biomarkers and genetic tests with higher specificity, further enhancing precision in the diagnosis and management of prostate cancer.
Keywords
Hrčak ID:
345160
URI
Publication date:
26.2.2026.
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