Prostate cancer remains a significant global health concern, and serum Prostate-Specific Antigen (PSA) levels are widely used for diagnosis and monitoring, though it lacks specificity. In India, prostate biopsy is usually recommended for serum PSA levels above 4 ng/mL. This study aimed to correlate serum PSA levels, prostate cancer prevalence, and Gleason grade groups, with emphasis on patients with serum PSA levels between 4.1 and 10 ng/mL.

We reviewed all Transrectal ultrasound guided prostate core biopsies received from January 2018 to June 2023. Patients with inadequate tissue, unavailable PSA data and post-treatment biopsies were excluded. Serum PSA levels were categorised and correlated with Gleason grade groups.

Among 734 patients, 56.3% (n=413) were malignant, with a median PSA of 25.9 ng/mL and 43.7% (n=321) were benign, with a median PSA of 9.9 ng/mL. In the malignant cohort (n=413), 65.9% had Gleason grade groups 3, 4 and 5, including three patients with neuroendocrine carcinoma. Patients with PSA levels between 4.1 and 10 ng/mL (n=231), 64% were benign, and 36% were malignant, of which 39.6% belonged to higher histological grades. Among patients with PSA >4 ng/ml in the benign cohort, 5.6% had granulomatous prostatitis, and 94.4% had subacute to chronic inflammation or hyperplastic changes

We highlight the vital role of serum PSA levels in conjunction with biopsy studies to diagnose prostate cancer. A comprehensive approach considering PSA levels alongside Gleason scores, digital rectal exam findings, and advanced imaging is crucial for improving diagnostic accuracy and patient outcomes.