Introduction:
Prostate cancer is one of the most common cancers diagnosed in men, especially in older age groups. Although prostate specific antigen (PSA) remains the most widely used screening tool, its low specificity often leads to unnecessary biopsies and treatment of harmless conditions. This review aims to present and compare the currently available prostate cancer biomarkers, focusing on how they can help reduce the number of unnecessary biopsies by improving the accuracy of diagnosis.

Material and methods:
A thorough analysis of the literature on key biomarkers was conducted: total PSA, percentage of free PSA (%fPSA), Prostate Health Index (PHI), 4-Kallikrein score (4Kscore), prostate cancer gene 3 (PCA3), Select Molecular Diagnostics test for prostate cancer risk assessment (SelectMDx), and ExoDx Prostate IntelliScore (EPI). Data regarding their sensitivity, specificity, diagnostic cut-off values, and real-world use were reviewed. Their availability and costs in Poland and across Europe were also examined.

Results:
While traditional PSA testing is highly sensitive (~93%) and can detect most cases of cancer, it lacks precision (~20% specificity), often flagging non-cancerous conditions. Newer tests are more reliable: %fPSA improves specificity up to 40%; PHI offers a balance of 75% sensitivity and 69% specificity; 4Kscore can reach up to 90% sensitivity and 76% specificity. Other tests, such as PCA3, SelectMDx, and EPI, also show promising results. These tools help doctors better identify which patients are truly at higher risk of aggressive prostate cancer and which can safely avoid a biopsy. However, their high price and limited reimbursement in public healthcare systems – especially in Poland – remain major obstacles.

Conclusions:
Modern biomarkers significantly improve the accuracy of prostate cancer detection compared to PSA alone. They can help many men avoid unnecessary and invasive procedures. Combining these tests with clinical evaluations and imaging may further improve diagnosis. To make them more widely available, we need more research, better funding, and official clinical recommendations.