| Antibiotics and observation have a similar impact on asymptomatic patients with a raised PSA. | |
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MedLine Citation:
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PMID: 21244610 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Flavio L Heldwein; Patrick E Teloken; Antonio A Hartmann; Ernani L Rhoden; Claudio Teloken |
Publication Detail:
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Type: Comparative Study; Journal Article Date: 2011-01-18 |
Journal Detail:
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Title: BJU international Volume: 107 ISSN: 1464-410X ISO Abbreviation: BJU Int. Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-04-26 Completed Date: 2011-06-21 Revised Date: 2012-05-17 |
Medline Journal Info:
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Nlm Unique ID: 100886721 Medline TA: BJU Int Country: England |
Other Details:
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Languages: eng Pagination: 1576-81 Citation Subset: IM |
Copyright Information:
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© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL. |
Affiliation:
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Division of Urology, Universidade do Sul de Santa Catarina, Florianopolis, Santa Catarina, Brazil. flavio.lobo@gmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Anti-Bacterial Agents; 82419-36-1/Ofloxacin; EC 3.4.21.77/Prostate-Specific Antigen |
| Comments/Corrections | |
Comment In:
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J Urol. 2012 May;187(5):1642-3
[PMID:
22494722
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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