In 20% of the men 50 years of age and older referred to a urological specialist clinic, a cancer, mostly a prostate cancer, was diagnosed. No symptom mentioned in the referral form was correlated to the diagnosis of a cancer. S-PSA density did not have a better predictive value than S-PSA alone. S-PSA 3.0 microg/L as a borderline for prostate biopsy or not had a 99.5% negative predictive value and only a slightly lower specificity then 4.0 microg/L. In clinical practice, for patients where curative treatment is feasible, S-PSA 3.0 microg/L appears to be a more appropriate borderline for prostate biopsy than 4 microg/L.