Aim: To generate a combination of serum zinc (Zn) and prostate-specific antigen (PSA) in an attempt to provide better prediction of prostate biopsy outcomes with Zn/PSA ratios. Materials & methods: Diagnostic performances of PSA and Zn/PSA were investigated using receiver operating characteristic and the area under the curve analysis and McNemar test in 480 men. Decision curve analysis was also used to determine the net clinical benefits of the two parameters. Results: The receiver operating characteristic-area under the curve analysis established a similar diagnostic performance for both parameters. Although Zn/PSA had a higher diagnostic sensitivity, PSA was superior in terms of specificity and net clinical benefits. Conclusion: Zn/PSA has no substantial superiority in the prediction of prostate biopsy outcomes.