Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis.
OBJECTIVE
To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs).


METHODS
A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared effects of empiric antibiotics with no treatment or placebo on lowering PSA levels and minimizing unnecessary PBs in patients with moderately increased PSA levels. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis.


RESULTS
The inclusion criteria for the study were met by 6 RCTs (1 placebo controlled and 5 no treatment controlled) involving 656 patients. The synthesized data from these RCTs indicated that there were no significant differences between the antibiotic and control groups in the PSA levels after treatment (mean difference [MD] = 0.15, 95% CI:-0.50 to 0.81, P = 0.65], number of patients with decreased PSA levels after treatment (relative risk [RR] = 1.22, 95% CI: 0.90-1.65, P = 0.20], prostate-specific antigen density levels after treatment (MD =-0.04, 95% CI:-0.15 to 0.07, P = 0.47), f/t% PSA after treatment (MD =-1.47, 95% CI:-4.65 to 1.71, P = 0.37), number of patients with responsive PSA (RR = 1.02, 95% CI: 0.58-1.81, P = 0.94), and individual Pca-positiverate in these patients (RR = 1.07, 95% CI: 0.53-2.16, P = 0.86), and Pca-positiverates (RR = 0.85, 95% CI: 0.48-1.50, P = 0.57). However, the antibiotic group had a significant change in the net PSA decrease after treatment compared with the control group (MD = 1.44, 95% CI: 0.70-2.17, P = 0.0001).


CONCLUSIONS
The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs.
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Lu
L
Yang
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Yuchun
Y
Zhu
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Zhuang
Z
Tang
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Yongji
Y
Chen
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Liang
L
Gao
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Liangren
L
Liu
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Ping
P
Han
Department of Urology, West China Hospital, Sichuan University, Chengdu, China. Electronic address: xiangli.87@163.com.
Xiang
X
Li
Department of Urology, West China Hospital, Sichuan University, Chengdu, China. Electronic address: weiqiang933@126.com.
Qiang
Q
Wei
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001706:Biopsy; D006801:Humans; D008297:Male; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology
D000900:Anti-Bacterial Agents; D017430:Prostate-Specific Antigen
Antibiotic; Prostate biopsy; Prostate cancer; Prostate-specific antigen; Randomized controlled trial