study were men of Arab origin residing in Kuwait. RESULTSIn all, 1700 men (mean age 55.6 years, range 35-94) were assessed; of these, 161 had a serum PSA of >10 ng/mL, attributable to benign prostatic hyperplasia (BPH) in 110 (68%), BPH with histological features of prostatitis in 33 (21%) and prostate cancer in 18 (11%). TRUS of the prostate in 143 of the 161 men with either BPH or BPH with prostatitis showed varying grades of intraprostatic calcifications in 22 (15%). Both PSA density and percentage free PSA did not contribute to determining the causes of total PSA levels of >10 ng/mL. There was a progressive decline in PSA in all patients with BPH and prostatitis, except one who at rebiopsy had prostate cancer (T1N0M0, G1). CONCLUSIONTotal PSA values of >10 ng/mL in Arab men may be a result of BPH, BPH with prostatitis or prostate cancer, in that order. A gradual decline in total PSA (decreased PSA velocity) with time to <4 ng/mL often confirms the diagnosis of BPH with prostatitis. The percentage of free PSA and PSA density may not be helpful in diagnosing prostate cancer with certainty in these patients. Compared with Caucasians in the USA and Europe, BPH and BPH with prostatitis appear to be more frequent causes of serum PSA levels of >10 ng/mL in Arab men.