Elevated serum prostate-specific antigen (PSA) in the setting of acute or chronic bacterial prostatitis is common. Serum PSA, however, is much more variable in the setting of chronic nonbacterial prostatitis. Because elevated serum PSA is associated with prostate cancer and is used in screening programs for prostate cancer, patients with benign causes for elevation of serum PSA present a challenge. This article reviews the management of patients with elevated serum PSA and a diagnosis of chronic nonbacterial prostatitis.