PSA levels of 4.0 - 10 ng/mL and negative digital rectal examination. Antibiotic therapy versus immediate prostate biopsy.
OBJECTIVE
The management of mildly elevated (4.0-10.0 ng/ml) prostate specific antigen (PSA) is uncertain. Immediate prostate biopsy, antibiotic treatment, or short term monitoring PSA level for 1-3 months is still in controversy.


METHODS
We conducted a retrospective chart review of patients in a large community practice (2003 - 2007) who had PSA levels between 4.0-10 ng/mL without any further evidence of infection. Data was gathered regarding patient's age, whether standard antibiotic therapy (10-14 days of ofloxacin or ciprofloxacin) had been administered before the second PSA measurement, results of a second PSA test performed at 1- to 2-month intervals, whether a prostate biopsy was performed and its result.


RESULTS
One-hundred and thirty-five men met the study inclusion criteria with 65 (48.1%) having received antibiotics (group 1); the PSA levels decreased in 39 (60%) of which, sixteen underwent a biopsy which demonstrated prostate cancer in 4 (25%). Twenty-six (40%) patients of group 1 exhibited no decrease in PSA levels; seventeen of them underwent a biopsy that demonstrated cancer in 2 (12%). The other 70 (51.9%) patients were not treated with antibiotics (group 2); the PSA levels decreased in 42 (60%) of which, thirteen underwent a biopsy which demonstrated prostate cancer in 4 (31%). In the other 28 (40%) patients of group 2 there was no demonstrated decrease in PSA, nineteen of these subjects underwent a biopsy that demonstrated cancer in 8 (42%).


CONCLUSIONS
There appears to be no advantage for administration of antibacterial therapy with initial PSA levels between 4-10 ng/mL without overt evidence of inflammation.
Department of Urology, Tel Aviv Central Consulting Clinic, Clalit Healthcare Services, Tel Aviv, Israel. shtrickeravi@hotmail.com
Avraham
A
Shtricker
Shai
S
Shefi
Avi
A
Ringel
Gabriel
G
Gillon
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D002939:Ciprofloxacin / Q000627:therapeutic use; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D015242:Ofloxacin / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000188:drug therapy; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012044:Regression Analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D015242:Ofloxacin; D017430:Prostate-Specific Antigen