Does PSA reduction after antibiotic therapy permits postpone prostate biopsy in asymptomatic men with PSA levels between 4 and 10ng/mL?

Abstract

Purpose We investigated the effect of antibiotics on PSA in asymptomatic patients with mild PSA elevation.Materials and Methods We prospectively evaluated, in a non-randomized design, 106 asymptomatic patients with PSA of 4-10ng/mL, with a negative digital rectal examination and with no urinary tract infection evidence for 2 years. Patients were divided into two groups: those treated with antibiotics for 3 weeks (G1) and those who were not treated (G2). PSA was taken six weeks after and prostate biopsy was performed in all patients.Results PCa was diagnosed in 25 of 106 patients (23.6%): 16 (25.0%) in G1 and 9 (21.4%) in G2 (p>0.05). PSA normalization was experienced in 24.5%. In G1, PSA returned to <4ng/mL in 15 (23.4%) patients compared to 11 (26%) patients in G2. In the patients with a positive biopsy, no significant variation was noted in PSA, fPSA, %fPSA and DPSA after antibiotic treatment. A significantly lower cancer detection rate was noted with decreased PSA, fPSA, and DPSA after antibiotic use. A PSA reduction rate of ≥10% occurred in 58.5%, and this was similar in both G1 and G2 groups. The sensibility, specificity and accuracy of PSA reduction of ≥10% were 31%, 23% and 25%, respectively.Conclusion Empirical antibiotic therapy in asymptomatic male patients is not related to PSA reduction. The greater than 10% PSA reduction after antibiotic in this population cannot postpone prostate biopsy.

Antibiotic therapy in patients with high prostate-specific antigen: Is it worth considering? A systematic review

“…The majority of studies were retrospective and nine studies were randomised controlled trials (RCTs) [4][5][6][7][8][9][10][11][12]. Furthermore, there were seven prospective non-randomised trials [13][14][15][16][17][18][19]. All studies reported on the variables indicated in the data extraction section and are listed in Table 1 [4-32, 34, 35].…”

Prostate Biopsy: Which Technique for Which Results at Lom&#233; University Hospital in 2017?

“…We conducted a 24-month prospective study (from January 2016 to December 2017) that included patients who had a prostate biopsy for the diagnosis of prostate cancer. The inclusion criteria were a total PSA level greater than 4 ng/ml [4] and/or a digital rectal abnormality. A biological assessment including blood crase and cytobacteriological examination of urine (ECBU) was done for each patient.…”

“…Despite a grid of the gland, the cancer detection rate in our series was surely below what it could be if we had had imaging guidance. Indeed, the standard prostate biopsy technique currently accepted is transrectal guided echo sampling [3], even though the latter would ignore about 20% of prostate cancer that would have required treatment [4]. To overcome these shortcomings, new guidance techniques are currently being used, including Magnetic Resonance Imaging (MRI), which significantly increases the clinically significant cancer detection rate as reported by Futterer [5].…”

Italian Prostate Biopsies Group: 2016 Updated Guidelines Insights

“…The PSA level should be verified after a few weeks using the same assay under standardized conditions (i.e. no ejaculation, manipulation, or urinary tract infection) in the laboratory using the same testing standard (11). Empiric use of antibiotics in an asymptomatic patient in order to lower the PSA level should not be undertaken even if it is common in current clinical practice (11).…”