Ciprofloxacin versus levofloxacin in avoidance of prostate biopsy in patients with isolated PSA elevation: a prospective randomized study

Abstract

The efficiencies of ciprofloxacin and levofloxacin on prostate-specific antigen (PSA) elevation were compared in terms of avoidance of prostate biopsy in this study. Materials and methods: Included in the study were 43 men with PSA levels of >=3.5 ng/mL. They were randomized into either ciprofloxacin or levofloxacin groups for a 3-week course. PSA and free PSA levels were measured before and after the antibiotherapy. The patients in whom PSA remained >=3.5 ng/mL after therapy underwent biopsy. Results: The average age of the men was 64.44 years (standard deviation: 9.54). Following antibiotics, 76.7% of the patients showed a reduction in PSA and 32.6% showed PSA normalization; PSA levels dropped by a rate of 27.1% (P < 0.001). In the ciprofloxacin group, the PSA reduction rate and PSA normalization were insignificantly higher than in the levofloxacin group. Ciprofloxacin caused a significant reduction in PSA (-41.6% change, P < 0.001), but levofloxacin did not (-5.6% change). With quinolones, positive predictive value improved from 9.3% to 13.8%. Of the 29 patients with persistent PSA levels of >=3.5 ng/mL after antibiotics, 4 were diagnosed with prostate cancer (13.8%). Conclusion: Empirical ciprofloxacin seems to be more effective than levofloxacin in men with isolated PSA elevation, leading to the avoidance of unnecessary prostate biopsy in nearly half of the cases, and enhances diagnostic capabilities of both PSA and prostate biopsy.