ROLE OF ANTIBIOTIC IN PREVENTING PROSTATE BIOPSY IN PATIENTS WITH PSA LEVEL 4-10 NG/ML WITH NORMAL DRE

Dr Ravi Ranjan, Dr Rakesh Ranjan, Dr Nabal Kumar Mishra

Abstract


Objectives- To evaluate the antibiotic treatment in preventing prostate biopsy in patients with PSA level 4-10 ng/ml with normal DRE.

Methods- The study was a prospective randomized open-label trial including 108 patients divided into study group (58patients) and control group (50 patients) done in the department of urology and renal transplant vmmc and safdarjung hospital new delhi, from october 2016 to october 2017.Study Group patients were given ofloxacin 400 mg twice daily for 4 weeks. PSA repeated. Patients again divided into 2 groups- PSA < 4ng/ml and PSA >4 ng/ml. Standard 12-core biopsy was done in all patients. Percentage of patients positive for malignancy were observed and analyzed in both groups. Control Group patients received multivitamin capsules for 4 weeks.

Results- 26 of 58 patients (44.8%) in study group and 8 of 50 patients (16%) in control group had decrease in PSA level below 4ng/ml. Among the study group patients, cancer was found in only 02 of 26 patients (7.6%) whose repeat PSA was below 4ng/ml whereas cancer was diagnosed in 14 of 32 patients (43.7%) whose repeat PSA was above 4ng/ml.

Conclusion- 4 weeks of ofloxacin treatment significantly decreases PSA in patients with levels between 4-10 ng/ml. Biopsy can be avoided in patients with repeat PSA<4ng/ml after antibiotic treatment. Larger randomized blinded control trials are required for arriving at a definitive conclusion

Keywords


prostate, psa, dre

Full Text:

PDF

References


Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.

Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, Petros JA, Andriole GL

N Engl J Med. 1991 Apr 25; 324(17):1156-61

Physiologic (intraindividual) variation of serum prostate-specific antigen in 814 men from a screening population.

Komatsu K, Wehner N, Prestigiacomo AF, Chen Z, Stamey TA

Urology. 1996 Mar; 47(3):343- 6

Prostate-specific antigen change in the European Randomized Study of Screening for Prostate Cancer, section Rotterdam.

Raaijmakers R, Wildhagen MF, Ito K, Pàez A, de Vries SH, Roobol MJ, Schröder FH

Urology. 2004 Feb; 63(2):316-20

Carver BS, Bozeman CB, Williams BJ, Venable DD.The prevalence of men with National Institutes of Health category IV prostatitis and association with serum prostate specific antigen. J Urol. 2003;169:589-912.

Anim JT, Kehinde EO, Sheikh MA, Prasad A, Mojiminiyi OA, Ali Y and Al-Awadi KA. Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis. Med PrincPract 2007; 16:53-58

Kaygisiz O, Uğurlu O, Koşan M, Inal G, Oztürk B, Cetinkaya M. Effects of antibacterial therapy on PSA change in the presence and absence of prostatic inflammation in patients with PSA levels between 4 and 10 ng/mL. Prostate Cancer Prostatic Dis. 2006;9:235-8

Bozeman CB, Carver BS, Eastham JA, Venable DD. Treatment of chronic prostatitis lowers serum prostate specific antigen. J Urol. 2002;167:1723-6

Schaeffer AJ, Wu SC, Tennenberg AM, Kahn JB. Treatment of chronic bacterial prostatitis with levofloxacin and ciprofloxacin lowers serum prostate specific antigen. J Urol. 2005;174:161-4.

Okada K, Kojima M, Naya Y, Kamoi K, Yokoyama K, Takamatsu T, et al. Correlation of histological inflammation in needle biopsy specimens with serum prostate-specific antigen levels in men with negative biopsy for prostate cancer. Urology.2000;55:892-8.

Serretta V, Catanese A, Daricello G, Liotta R, Allegro R, Martorana A, et al. PSA reduction (after antibiotics) permits to avoid or postpone prostate biopsy in selected patients. Prostate Cancer Prostatic Dis. 2008;11:148-5

Potts JM. Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate specific antigen. J Urol. 2000;164:1550-3.

Stopiglia RM, Ferreira U, Silva MM Jr, Matheus WE, Denardi F, Reis LO. Prostate specific antigen decrease and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial. J Urol. 2010;183:940-4

Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronicpelvic pain syndrome. Ann Rev Med. 2006; 57:195-206

Scardino PT. The responsible use of antibiotics for an elevated PSA level. Nat ClinPract Urol. 2007

Faydaci G, Eryildirim B, Tarhan F, Goktas C, Tosun C, Kuyumcuoglu U. Does antibiotic therapy prevent unnecessary prostate biopsies in patients with high PSA values? ActasUrol Esp. 2012;36:234-8.


Refbacks

  • There are currently no refbacks.