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Serum prostate specific antigen (PSA) is the only biomarker routinely used for the early detection of prostate cancer, but it is not a perfect test. Although PSA is highly specific for prostate, an elevated level is not specific for cancer, being increased in benign hyperplasia and prostatitis (Pungalia, 2006; Bozeman, 2002). Consequently, the majority of men with an increased serum PSA do not have prostate cancer and thus undergo unnecessary prostate biopsies. Data from the USA estimate that of the million prostate biopsies performed annually, only 235,000 cases of cancer are detected, or that more than 750,000 men underwent a biopsy based on an elevated PSA caused by benign disease (Fadore, 2004; Jemal, 2006). Published data from the Prostate Cancer Prevention Trail showed that there is no cut-off point for serum PSA; for values up to 4ng/ml the sensibility of the test showed a variation of between 21% and 83%, a specificity of between 39% to 94%, with a positive predictive value of between 7% and 27% (Thompson, 2005).

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Future Aspects of Prostate Biopsy – The Use of Primary Circulating Prostate Cells to Select Patients for Prostate Biopsy: Evidence, Utility and Cost-Benefit