Since its introduction into clinical practice in the 1990s, serum PSA (prostate specific antigen) testing is now one of the most important methods for prostate cancer screening, treatment evaluation, and recurrence monitoring. However, patients with total serum PSA >4 mol/l have no prostate cancer in nearly 70% of the patients with puncture results. Studies have shown that increased serum PSA may be due to destruction of prostate duct cells leading to PSA release into the circulation, a condition that can occur in benign and malignant diseases of the prostate (prostatitis, prostate cancer, benign prostatic hyperplasia) as well as during urologic manipulations (prostate massage, prostate puncture biopsy). Early studies showed a gradual increase in serum PSA with age as well as with prostate volume in non-prostate cancer disease, and a more pronounced increase in serum PSA in patients with benign prostatic hyperplasia. Recently, there is increasing evidence that inflammation of the prostate, especially chronic prostatitis, is strongly associated with elevated serum PSA levels. In fact, histologic prostatitis is prevalent in puncture specimens of the prostate in older men, often coexisting with benign prostatic hyperplasia as the patient ages and as the prostate gradually increases in size. BPH with chronic prostatitis not only leads to lower urinary tract symptoms and other symptoms that affect the patient’s quality of life, but its concomitant increased serum PSA increases the psychological burden of the patient and increases the risk of prostate puncture. Some clinical studies have attempted to reduce the risk of prostate puncture by lowering serum PSA with antibiotics and anti-inflammatory methods, and have achieved significant results.