Antibiotic therapy in patients with high prostate-specific antigen: Is it worth considering? A systematic review

Abstract

Objective: To address the question of whether antibiotic therapy can obviate the need for prostate biopsy (PBx) in patients presenting with high prostate-specific antigen (PSA) levels.Methods: With the increase in unnecessary PBx in men with high PSA levels, a systematic review was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Results: The literature search yielded 42 studies, of which 11 were excluded due to irrelevance of data. Most of the studies were retrospective, nine studies were randomised controlled trials, and there were seven prospective non-randomised trials. The age range of the patients was 51-95 years. Antibiotics, predominantly ofloxacin or ciprofloxacin, combined with a nonsteroidal anti-inflammatory drug (NSAID) or not, were prescribed for 2-8 weeks. All studies focussed on PSA levels ranging from ≤ 4 to ≥ 10 ng/mL. Furthermore, antibiotic therapy normalised PSA levels by a wide variety of percentages (16-59%), and the PSA level decrease also varied widely and ranged from 17% to 80%. For patients who had unchanged or decreased PSA, carcinoma was found in 40-52% and 7.7-20.3%, respectively. No cancer was detected if the PSA level decreased to < 4 ng/mL. Conclusion: Antibiotic therapy is clinically beneficial in patients with high PSA levels. PSA reduction or normalisation after medical therapy, either antibiotic and/or NSAID, for ≥ 2 weeks can avoid unnecessary PBx. Antibiotic therapy is more beneficial when the PSA level is < 20 ng/mL. Abbreviations: EPS: expressed prostatic secretion; PBx: prostate biopsy; (%f)(f/t)(t)PSA, (percentage free) (free/total) (total) serum PSA; PSAD: PSA density; RCT: randomised controlled trial; VB3: voided bladder urine 3 ARTICLE HISTORY

Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center

“…Clavien-Dindo complications grade 3 to 5 have never occurred. The distribution of adverse events in this study is truly interesting since, in front of a meaningful higher rate of complications, there were no serious events requiring medical intervention while most of the authors, on the contrary, report some complications of grade 3 or even more in their series [ 10 , 15 , 18 , 21 , 35 , 36 ]. Some authors have chosen not to report complications below grade 3, evidently considering them not significant [ 7 , 29 ].…”

Delaying a Biopsy With Serial Prostate-Specific Antigen Checkup Helps to Identify a Significant Prostate Cancer: A Strategy to Evade Unnecessary Procedures

“…In a recent meta-analysis of 31 different series including 8 randomized clinical trials, more than 2 weeks of antibiotic therapy was reported to be beneficial for detecting PCa when PSA was <20 ng/mL. 16 reported to show a PSA decrease over 8 weeks after alpha-blocker administration, 12 even compared with the range of 17%-80% in PSA decrease of antibiotic studies with shorter-term duration. 15 Because the majority of the subject who agreed to delay their biopsy by initial presentation was willing to go to refuse the planned biopsy after the normalization of PSA level from the baseline, their cancer status was not investigated in this study.…”

The Effect of Ciprofloxacin on Prostate-Specific Antigen (PSA)

“…Despite the controversy surrounding the value of antibiotics in reducing higher PSA levels, some urologists in daily practice often prescribe antibiotics before prostate biopsy to men with newly elevated PSA levels. The reduction of PSA levels after the administration of antibiotics can identify patients whose prostate biopsy can be avoided (Özman O & Talat Z, 2019;Taha et al, 2020).…”

“…The use of antibiotics in patients with elevated PSA levels of >4 ng/mL may avoid prostate biopsy examinations. The decrease in PSA levels with the use of antibiotics varies from 17% to 80% of cases (Taha et al, 2020). Therefore, researchers are interested in conducting research on the effect of antibiotic administration on PSA levels of patients with suspected prostate cancer.…”