Abstract
The management of mildly elevated (4.0-10.0 ng/ml) prostate specific antigen (PSA) is uncertain. Immediate prostate biopsy, antibiotic treatment, or short term monitoring PSA level for 1-3 months is still in controversy. We conducted a retrospective chart review of patients in a large community practice (2003 - 2007) who had PSA levels between 4.0-10 ng/mL without any further evidence of infection. Data was gathered regarding patient's age, whether standard antibiotic therapy (10-14 days of ofloxacin or ciprofloxacin) had been administered before the second PSA measurement, results of a second PSA test performed at 1- to 2-month intervals, whether a prostate biopsy was performed and its result. One-hundred and thirty-five men met the study inclusion criteria with 65 (48.1%) having received antibiotics (group 1); the PSA levels decreased in 39 (60%) of which, sixteen underwent a biopsy which demonstrated prostate cancer in 4 (25%). Twenty-six (40%) patients of group 1 exhibited no decrease in PSA levels; seventeen of them underwent a biopsy that demonstrated cancer in 2 (12%). The other 70 (51.9%) patients were not treated with antibiotics (group 2); the PSA levels decreased in 42 (60%) of which, thirteen underwent a biopsy which demonstrated prostate cancer in 4 (31%). In the other 28 (40%) patients of group 2 there was no demonstrated decrease in PSA, nineteen of these subjects underwent a biopsy that demonstrated cancer in 8 (42%). There appears to be no advantage for administration of antibacterial therapy with initial PSA levels between 4-10 ng/mL without overt evidence of inflammation.
Highlights
The prostate-specific antigen (PSA) level is considered one of the most prevalent cancer markers in current clinical practice
The data collected included the patient’s age, whether standard antibiotic therapy (10-14 days of ofloxacin or ciprofloxacin) had been given before the second PSA measurement, based on the urologist’s own decision, the results of the second PSA test that was done after a 1- to 2-month interval, whether a TRUS guided prostate biopsy was eventually performed and, if so, the result
In 26 (40%) patients of group 1 no decrease in PSA levels were exhibited, seventeen of them underwent biopsies which demonstrated cancer in 2 (12%), chronic inflammation in 8 (47%) and benign prostatic hyperplasia (BPH) in the rest .The other 70 (51.9%) patients were not treated with antibiotics: the PSA levels decreased in 42 (60%) of them, thirteen underwent a biopsy which demonstrated prostate cancer in 4 (31%),chronic inflammation in 2(15.4%) and BPH in the rest
Summary
The prostate-specific antigen (PSA) level is considered one of the most prevalent cancer markers in current clinical practice. The use of antibiotics would appear to PSA Levels of 4.0 – 10 ng/ml and Negative DRE be the most sound, given that unproven sub clinical prostatitis, and not malignancy, leads to the majority of cases of spurious PSA elevation [1,2,3,4,5,6,7]. In an effort to achieve a more effective indication for dealing with PSA elevation in the community, we conducted a retrospective study for evaluating the effect of antibiotics on PSA levels in patients who have a negative DRE yet possess an initially mild PSA elevation (4.0-10 ng/mL) and negative clinical and laboratory signs of prostate or urinary infection. Can the antibiotic therapy contribute to obviate unnecessary prostate biopsy
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