PSA Reduction (after Antibiotics) Permits To Avoid Or Postpone Prostate Biopsy In Selected Patients

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 13 Jul 2008 - 0:00 PDT

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UroToday.com - In Prostate Cancer and Prostatic Diseases, a group from Palermo, Italy report on the use of antibiotics in patients with an elevated PSA. The study cohort consisted of 94 Caucasian men with a PSA between 4 and 10ng/ml, no symptoms of prostatitis, a negative rectal exam for cancer and who were otherwise candidates for prostate biopsy. All patients had a negative urinalysis and at least 2 previous elevated PSA detections with no greater than a 10% increase. Total and free PSA were repeated in all patients at study entry. Ciprofloxacin (500mg twice daily) was given to all patients for 3 weeks. Total and free PSA was rechecked 2 weeks after completing therapy. Patients then underwent prostate biopsy 2-4 weeks later. A total of 12-21 cores were obtained from each patient.

Median prostate volume was 37cc and median total PSA was 7.3ng/ml. After antibiotics, 59 patients (59.6%) showed total PSA reduction and in 8 of these PSA decreased below 4ng/ml. The mean and median PSA reduction rates were 28% and 22%, respectively. PSA ratio remained almost unchanged, with a median value of 0.16 and a median rate of change of 6%. This is because free PSA varied according to total PSA. Histology demonstrated BPH, prostate cancer and prostatitis in 65.7%, 28.3%, and 6% of patients, respectively. No difference was found between the PSA reduction rate after antibiotics and the grade of inflammation. Median PSA reduction was 10.2% and 14.9% in patients with grade 0-1 and 2-3 inflammation, respectively.

Prostate cancer was found in 16 men (40%) of 40 cases with increased or unchanged PSA and in 12 (20.3%) out of 59 men showing PSA reduction. In 9 patients with a PSA lowered to les than 70% of the basal value and/or decreased below 4ng/ml, no cancer was detected. PSA reduction rate showed an independent strong correlation with the absence of prostate cancer at biopsy. For PSA reduction rates over 50% and 70%, PSA sensitivity was 75% and 100% and negative predictive value was 77% and 100%, respectively.

Serretta V, Catanese A, Daricello G, Liotta R, Allegro R, Martorana A, Aragona F, Melloni D.
Prostate Cancer Prostatic Dis. 2008;11(2):148-52

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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