Bulbul Muhammad A, Wazzan Wassim, Hijaz Adonis, Shaar Ahmad
Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
J Med Liban. 2002 Jan-Apr;50(1-2):23-5.
65-70% of patients with abnormal prostate specific antigen (PSA) do not have cancer on prostate needle biopsy. Prostate biopsy is a potentially morbid procedure. Prostatitis is commonly reported on needle biopsies. To cut down on the number of unnecessary prostate biopsies we evaluated the effect of antibiotic on PSA level in patients with lower urinary tract symptoms (LUTS), normal digital rectal examination (DRE), normal urinalysis and elevated PSA.
48 selected patients with LUTS, normal DRE, normal urinalysis and elevated PSA (range 5.0-28.5 ng/ml), that usually will undergo prostate biopsy, received 2 weeks of Ciprofloxacin. An alpha-blocker was added if the patient was bothered. PSA was repeated and prostate biopsy was performed if PSA did not drop.
25/48 patients (52%) dropped their PSA (median of 42% drop), with 80% improvement in LUTS, were not biopsied. 23/48 patients (48%) did not drop their PSA, with 65% improvement in LUTS, were biopsied. 9/23 patients (39%) had prostate cancer.
Almost 50% of patients with LUTS, normal DRE and elevated PSA will drop their PSA following 2 weeks of Ciprofloxacin thus by avoiding prostate biopsy. This needs to be done in a very strict manner with careful follow-up of those patients dropping their PSA especially not to normal levels.
65% - 70%前列腺特异性抗原（PSA）异常的患者经前列腺穿刺活检后并无癌症。前列腺活检是一种存在潜在风险的操作。针吸活检中常报告有前列腺炎。为减少不必要的前列腺活检数量，我们评估了抗生素对下尿路症状（LUTS）、直肠指检（DRE）正常、尿液分析正常但PSA升高的患者PSA水平的影响。
48例经挑选的LUTS患者，DRE正常，尿液分析正常且PSA升高（范围为5.0 - 28.5 ng/ml），这些患者通常会接受前列腺活检，他们接受了为期2周的环丙沙星治疗。若患者感到不适，则加用α受体阻滞剂。若PSA未下降，则复查PSA并进行前列腺活检。
25/48例患者（52%）PSA下降（平均下降42%），LUTS改善80%，未接受活检。23/48例患者（48%）PSA未下降，LUTS改善65%，接受了活检。9/23例患者（39%）患有前列腺癌。
近50% LUTS、DRE正常且PSA升高的患者在接受2周环丙沙星治疗后PSA会下降，从而避免前列腺活检。对于PSA下降的患者，尤其是未降至正常水平的患者，必须严格进行密切随访。
