Abstract
ABSTRACTObjective: To address the question of whether antibiotic therapy can obviate the need for prostate biopsy (PBx) in patients presenting with high prostate-specific antigen (PSA) levels.Methods: With the increase in unnecessary PBx in men with high PSA levels, a systematic review was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.Results: The literature search yielded 42 studies, of which 11 were excluded due to irrelevance of data. Most of the studies were retrospective, nine studies were randomised controlled trials, and there were seven prospective non-randomised trials. The age range of the patients was 51–95 years. Antibiotics, predominantly ofloxacin or ciprofloxacin, combined with a non-steroidal anti-inflammatory drug (NSAID) or not, were prescribed for 2–8 weeks. All studies focussed on PSA levels ranging from ≤ 4 to ≥ 10 ng/mL. Furthermore, antibiotic therapy normalised PSA levels by a wide variety of percentages (16–59%), and the PSA level decrease also varied widely and ranged from 17% to 80%. For patients who had unchanged or decreased PSA, carcinoma was found in 40–52% and 7.7–20.3%, respectively. No cancer was detected if the PSA level decreased to < 4 ng/mL.Conclusion: Antibiotic therapy is clinically beneficial in patients with high PSA levels. PSA reduction or normalisation after medical therapy, either antibiotic and/or NSAID, for ≥ 2 weeks can avoid unnecessary PBx. Antibiotic therapy is more beneficial when the PSA level is < 20 ng/mL.Abbreviations: EPS: expressed prostatic secretion; PBx: prostate biopsy; (%f)(f/t)(t)PSA, (percentage free) (free/total) (total) serum PSA; PSAD: PSA density; RCT: randomised controlled trial; VB3: voided bladder urine 3
Highlights
In daily practice, some urologists often prescribe antibiotics before prostate biopsy (PBx) to men with a newly increased prostate-specific antigen (PSA) to decrease inflammation-induced PSA elevation and help to reduce unnecessary PBx
Others have reported that antibiotic treatment has no significant effect on the PSA level and that a lowered level of PSA after antibiotic treatment does not mean a decreased risk of prostate cancer [1]
In the present review we aimed to address the controversy of whether antibiotic treatment can exclude inflammation in the differential diagnosis of PSA
Summary
Some urologists often prescribe antibiotics before prostate biopsy (PBx) to men with a newly increased PSA to decrease inflammation-induced PSA elevation and help to reduce unnecessary PBx. others have reported that antibiotic treatment has no significant effect on the PSA level and that a lowered level of PSA after antibiotic treatment does not mean a decreased risk of prostate cancer [1]. Prostatitis is commonly reported on needle biopsies and 65–70% of patients with abnormal PSA levels do not have cancer on prostate needle biopsy. After a 2-year clinical and biochemical follow-up of symptomatic men who had a high PSA level and a normal DRE, and normal repeat PSA level, PBx can be safely avoided [2]. Elevation and can avoid unnecessary PBx. We considered patients with LUTS, normal DRE and normal urine analysis, and elevated PSA levels
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