Abstract
Objective: To investigate the causes of elevated prostate specific antigen (PSA) levels in patients with lower urinary tract symptoms (LUTS) through transrectal ultrasound guided biopsy (TRUS biopsy), regardless of prostate volume.

Methods: Retrospective study was conducted between January 2008 and December 2009 to find the cause of elevated PSA levels in sixty six (N=66) patients from the outpatient department in Guryyte General Hospital, Aljouf. Age of the patients was between 52 and 90 years and PSA level ranged between 5 ng/ml and 26 ng/ml. All patients were presented with some degree of lower urinary tract symptoms (LUTS) and high PSA levels for age. They underwent TRUS biopsies performed by a Radiologist and Urologist

Results: Out of the total sixty six patients, twenty two (33%) of them with a PSA range between 5.1ng/ml and 26 ng/ml were found to have Benign Prostatic Hyperplasia (BPH) and Prostatitis. Eighteen patients (29.5%) with a PSA level between 9.3 ng/ml and 25.6 ng/ml were diagnosed as adenocarcinoma of the prostate. Sixteen patients with PSA between 12ng/ ml and 26 ng/ml were diagnosed as BPH. Ten patients with PSA between 9.3ng/ml and 16 ng/ml were found to have Prostatitis (15.15%).

Conclusion: Benign prostate hyperplasia and chronic prostatitis are the two major causes of elevated serum PSA in our cohort followed by prostate cancer. With regards to the PSA level in chronic prostatitis and in prostate cancer, no significant difference was noted. The conclusion reached is that TRUS biopsy is mandatory to determine the exact cause of an elevated PSA level.