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The Prostatic Specific Antigen (PSA) is one of the best tumour markers currently available, and it is widely employed in the diagnosis and follow up of prostate cancer. Nevertheless, it is not specific for prostatic carcinoma, and an increase in its serum levels can also be related to benign prostatic hyperplasia, inflammation/infection or traumatic manoeuvres on the prostatic gland. Because of its well-known clinical features acute prostatitis does not require PSA evaluation for diagnosis, but other prostatitis (such as category IV NIH prostatitis) can be responsible of an increase in PSA levels without associated symptoms. Category IV prostatitis has a fairly high prevalence, affecting about one third of the adult males. Recently some studies have showed that approximately half of the patients with PSA levels in the grey zone and without symptoms of prostatitis undergo a decrease in PSA levels after a 2-4-week treatment with antibiotics. Thanks to this approach, 20-30% of the patients obtain PSA normalization and consequently avoid prostatic biopsies. In conclusion, the use of antibiotic treatment allows an increase in PSA specificity and a decrease in the number of unnecessary prostatic biopsies. The cost-benefit ratio of this approach has to be verified by means of prospective randomized trials.

The incidence of prostate cancer is remarkably increased in the last decade. This dramatic epidemiological change can be primarily attributed to the widespread use of prostate specific antigen (PSA) as a diagnostic tool. Nowadays most of the prostate cancers are detected at an early stage and the age of the patients is decreased. This has led to a significantly increase in the number of prostate cancer patients treated by radical prostatectomy. Serum determination of PSA is the standard method to monitor the disease after radical surgery, while other tests can be required only when PSA is detectable. After radical prostatectomy the mean half-life of PSA is 1.5 days and it must become undetectable to consider a patient free of disease. A value greater than 0.4 ng/ml, with an increase in two determination, indicates a recurrence of the disease. PSA is an extremely sensitive marker. In fact, in patients who underwent radical prostatectomy, the presence of detectable serum PSA levels allows to detect tumor recurrence even before any other diagnostic investigation (radiological or scintigraphical) becomes able to document it ("serological" disease). Unfortunately, increasing serum PSA levels do not reveal whether a patient is affected by local relapse or by metastases, with obvious repercussion for the therapeutic choice. Clinical examination of the patient, together with random and echoguided biopsies of the vesico-urethral anastomosis, do not reveal all cases of local recurrence. Ongoing study are evaluating other diagnostic tools in the monitoring patients after radical prostatectomy, such as the serum chromogranin A, the reverse transcriptase-polymerase chain reaction for PSA and prostate specific membrane antigen (PSMA), the Positron Emission Tomography and the immunoscintigraphy with radiolabeled monoclonal antibody directed toward the PSMA.