Prostate Cancer Can Be Detected Even in Patients with Decreased PSA Less than 2.5 ng/ml after Treatment of Chronic Prostatitis

Abstract

PurposeWe evaluated men with documented chronic prostatitis and elevated serum prostate-specific antigen (PSA) to determine whether treatment with antibiotics and anti-inflammatory drugs can lower serum PSA and the cancer detection rate in patients with post-treatment PSA <4 ng/ml.Materials and MethodsEighty-six men who presented with serum PSA greater than 4 ng/ml and who were subsequently diagnosed with chronic prostatitis with greater than 10 white blood cells per high power field in expressed prostatic excretions were included in this prospective study. Patients meeting these criteria underwent treatment with a 4-week course of antibiotics and nonsteroidal anti-inflammatory agents. Follow-up PSA and transrectal ultrasonography-guided prostate biopsy were performed within 2 months of treatment for all patients.ResultsMean patient age was 56.2 years (range, 37-72 years). Mean PSA (ng/ml) decreased by 33.8%, from 8.12 (range, 4.02-24.8) to 5.37 (range, 1.35-12.94), after treatment (p=0.001). Pathological studies revealed prostate cancer in 18 cases (20.9%), chronic inflammation in 64 (74.4%), and benign prostatic hypertrophy in 4 (4.7%). The prostate cancer detection rate according to the follow-up PSA level, below 2.5, from 2.5 to 4.0, and above 4.0, was 13.3% (2/15), 13.6% (3/22), and 26.5% (13/49), respectively.ConclusionsWhen chronic prostatitis with elevated PSA is identified, antibiotic and anti-inflammatory treatment can lower these PSA levels. However, the possibility of prostate cancer remains in patients whose PSA level decreases to less than 4 ng/ml, even in those with a PSA level less than 2.5 ng/ml.

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

“…The majority of studies were retrospective and nine studies were randomised controlled trials (RCTs) [4][5][6][7][8][9][10][11][12]. Furthermore, there were seven prospective non-randomised trials [13][14][15][16][17][18][19]. All studies reported on the variables indicated in the data extraction section and are listed in Table 1 [4-32, 34, 35].…”

“…Six studies used ofloxacin [4,8,10,13,15,16], six studies used 500 mg ciprofloxacin [5,9,17,19,21,23], and five used levofloxacin [6,9,12,28]. Six studies combined the antibiotic therapy with NSAIDs [4,5,18,20,23,25]. Huang et al [21] added the plant extracts, Ningbitai and Yunnan Baiyao capsule, to the antibiotic therapy.…”

“…All studies focussed on PSA levels ranging from 4 to 10 ng/mL. Some studies assessed PSA levels <4 ng/mL [6,18] and others assessed levels >10 ng/mL [9,16,19,21].…”

“…The majority of studies addressed the effect of antibiotics on the acutely inflamed prostate, whilst some of the other studies reported on documented chronic inflamed type [4,7,9,18,20,21,25,29].…”

Efficacy of Repeated Transrectal Prostate Biopsy in Men Younger Than 50 Years With an Elevated Prostate-Specific Antigen Concentration (>3.0 ng/mL): Risks and Benefits Based on Biopsy Results and Follow-up Status

“…Kim et al [16] showed that the mean PSA concentration decreased significantly after 4 weeks of treatment with antibiotics and nonsteroidal anti-inflammatory agents. A relatively high rate of cancer (13.5%, 5/37) was detected in patients with a PSA value that decreased to a normal value (<4 ng/mL) after treatment.…”