Document Detail


Antibiotics and observation have a similar impact on asymptomatic patients with a raised PSA.
MedLine Citation:
PMID:  21244610     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: • To compare the influence of a 4-week course of empirical antimicrobial therapy or observation on the prostate-specific antigen (PSA) levels of asymptomatic patients with a raised baseline PSA. • To identify whether a decrease in PSA can predict the risk of prostate cancer (PCa) detection on prostate biopsy.
PATIENTS AND METHODS: • Patients were referred to our ambulatory centre because of a raised PSA level (>2.5 ng/mL) with a normal digital rectal examination. A 12-core prostate biopsy was indicated in these patients and they were offered antibiotic treatment with levofloxacin 500 mg daily for 30 days. • Patients who did not agree to use antibiotics but who still showed interest in participating underwent simple observation, serving as controls. • Total and free PSA levels at baseline and after 45 days were measured. Variation in PSA level was calculated. • All patients underwent a 12-core prostate biopsy 6 weeks after the initial visit.
RESULTS: • In all, 245 men were enrolled, but 43 were lost due to follow-up. A total of 145 patients who used antibiotics and 57 controls were included in the analysis. • The median baseline PSA levels were 7.6 and 7.7 ng/mL in the antibiotic and control groups, respectively, with median follow-up levels of 6.8 and 7.0 ng/mL. The follow-up PSA level was significantly lower than the initial PSA level (P = 0.009). • Mean absolute and percentage variation in PSA level were similar in both groups (P = 0.828 and 0.128, respectively). • The overall PCa detection rate was 15.8%, and did not differ among the groups (P = 0.203). Regarding the percentage variation in PSA level, patients diagnosed with PCa tended to have their PSA level increased (22.4 vs -5.3%; P = 0.001). Indeed, a decrease of 20% in PSA was not predictive of a negative prostate biopsy (P = 0.41). • The area under the receiver operating characteristic curve for percentage PSA variation as a predictor of PCa was 0.660.
CONCLUSIONS: • PSA levels tend to fall when repeated after 45 days, regardless of antibiotic use. • Despite being associated with the chance of PCa, no percentage PSA variation threshold value exhibits satisfactory discriminatory properties.
Authors:
Flavio L Heldwein; Patrick E Teloken; Antonio A Hartmann; Ernani L Rhoden; Claudio Teloken
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-01-18
Journal Detail:
Title:  BJU international     Volume:  107     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-26     Completed Date:  2011-06-21     Revised Date:  2012-05-17    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  1576-81     Citation Subset:  IM    
Copyright Information:
© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.
Affiliation:
Division of Urology, Universidade do Sul de Santa Catarina, Florianopolis, Santa Catarina, Brazil. flavio.lobo@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Biopsy, Needle
Epidemiologic Methods
Humans
Male
Middle Aged
Ofloxacin / therapeutic use*
Prostate-Specific Antigen / blood*
Prostatic Neoplasms / blood,  diagnosis*,  drug therapy
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 82419-36-1/Ofloxacin; EC 3.4.21.77/Prostate-Specific Antigen
Comments/Corrections
Comment In:
J Urol. 2012 May;187(5):1642-3   [PMID:  22494722 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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