Purpose: Serum prostate-specific antigen (PSA) has a restricted predictive value for prostate cancer in the low-intermediate PSA range (2.5 - 10 ng/ ml). Our aim was to determine the predictive value of the International Prostate Symptom Score (IPSS) for positive prostate needle biopsy (PNB) in patients who underwent transrectal ultrasound (TRUS)- guided prostate biopsy with a low-intermediate PSA level. Patients and Methods: Between 2001 and 2004, the data of 389 consecutive patients applying for any urologic complaint to our department and who underwent TRUS- guided prostate biopsy due to an elevated serum PSA and/ or abnormal digital rectal examination (DRE) were retrospectively analyzed. A total of 158 eligible patients with a low- intermediate PSA level were included in the study. The patient's age, PSA, free PSA, free/ total PSA, prostate volume, PSA density (PSAD), pre- biopsy IPSS were compared in the positive and negative biopsy groups. Results: Fifty- eight of 158 patients (37%) who underwent TRUS- guided prostate biopsy had positive PNBs. Forty- eight patients (30%) had abnormal DREs. In the positive PNB group, the mean age was older and PSAD was higher, but the means of the prostate volumes and total IPSS were lower (p < 0.05). Multivariate analysis demonstrated that age and IPSS were independent predictors of a positive PNB ( p < 0.05). The odds ratio of mild IPSS for positive PNB controlled for age was 3.0 (95% CI 1.5 - 6.7). Receiver- operating characteristics analysis revealed a mild IPSS (AUC = 0.640) and was a considerable predictor for positive PNB as well as PSAD (AUC = 0.648). The sensitivity and specifi city of IPSS with a cutoff value of 7.5 points were 31 and 87% for prediction of prostate cancer detection. Conclusion: In the low- intermediate PSA range, mild IPSS may be a predictive factor for positive PNB with a similar specifi city of PSAD. Copyright (c) 2005 S. Karger AG, Basel.