PSA reduction (after antibiotics) permits to avoid or postpone prostate biopsy in selected patients

Abstract

Microscopic foci of prostatitis may induce prostate-specific antigen (PSA) increase. PSA reduction after antibiotics might identify those patients in whom biopsy can be avoided. Ninety-nine patients received ciprofloxacin for 3 weeks, of whom 59 showed PSA reduction. Histology detected small foci of prostatitis in 65% of cases. Carcinoma was found in 40 and 20.3% of patients with unchanged or decreased PSA, respectively (P ¼ 0.03). No cancer was detected if PSA decreased below 4 ng/ml or more than 70%. Biopsy can be postponed, with a low risk of missing a cancer, if PSA decreases more than 70% or below 4 ng/ml.

The Effect of Antibiotherapy on Prostate-Specific Antigen Levels and Prostate Biopsy Results in Patients with Levels 2.5 to 10 ng/mL

“…18 Baltaci and colleagues 24 reported that there were still some PCa patients with PSA levels < 4 ng/mL after an antibiotic course, while in contrast, no PCa was found in some studies 8,15,25 Many studies have reported a decline in PSA levels ranging from 7.1% to 43% after antibiotic treatment. 8,14,15,23,25 The PSA variability may also be because of diurnal biologic fluctuation. 22,26 It is known that there can even be a 20% to 46% difference between two consecutive PSA levels in one person.…”

“…They reported that 40% and 20.3% of patients diagnosed with PCa had unchanged and decreased PSA levels, respectively. 25 In addition, no cancer was detected in patients with a PSA level below 4 ng/mL, and the study suggested that biopsy could be postponed if PSA levels decreased more than 50% or below 4 ng/ml. Inclusion of patients with a previous history of biopsy and variability in the number of cores, ranging from 12 to 21, limit this study, however.…”

“…Serretta and coworkers 25 showed no prominent change in f/tPSA ratio on consequent PSA levels before and after antibiotic treatment. Another study, however, demonstrated that the f/t PSA rate increased after antibiotics.…”

“…Serratta and coworkers 25 found that there was a PSA reduction in 59% of patients after a 3-week course of antibiotics. They reported that 40% and 20.3% of patients diagnosed with PCa had unchanged and decreased PSA levels, respectively.…”

Antimicrobial Therapy for Asymptomatic Patients with Elevated Prostate-Specific Antigen: Can the Change in Prostate-Specific Antigen Reliably Guide Prostate Biopsy Decisions?

“…In the studies by Karazanashvili and Managadze [5] , Kobayashi et al [6] and Teronne et al [14] , a course of fluoroquinolones (different agents and durations 2-3 weeks) was found to decrease PSA in patients with laboratory criteria for asymptomatic prostatitis, and the authors recommended this approach to decrease the number of unnecessary prostate biopsies. In the studies by Seretta et al [15] , Lorente et al [16] and Guercio et al [17] , patients with subclinical histological foci of prostatitis also experienced a decrease in PSA that was sufficient in their opinion to postpone or avoid prostate biopsy in a number of patients with initially elevated PSA. On the other hand, in the randomized clinical trial by Stopiglia et al [7] , a decrease in total PSA was observed in a percentage of patients who received an antibiotic and patients who received a placebo, with no statistically significant differences between the two groups.…”