Baltaci Sümer, Süer Evren, Haliloğlu Ahmet Hakan, Gokce Mehmet Ilker, Elhan Atilla Halil, Bedük Yaşar
Department of Urology, University of Ankara, Faculty of Medicine, Turkey.
J Urol. 2009 Jan;181(1):128-32. doi: 10.1016/j.juro.2008.09.020. Epub 2008 Nov 13.
Although there is controversy surrounding this subject, some urologists in daily practice often prescribe antibiotics before biopsy to men with a newly increased prostate specific antigen. We evaluated the effects of antibiotics on serum total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density in men with prostate specific antigen between 4 and 10 ng/ml and normal digital rectal examination. We also investigated the incidence of prostate cancer after antibiotic treatment by performing prostate biopsies in all patients regardless of posttreatment prostate specific antigen.
Between May 2006 and April 2008 a total of 100 men with total prostate specific antigen between 4 and 10 ng/ml were enrolled in this study. In addition to total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density values were evaluated for all of the patients. Patients with pathological digital rectal examination and urinalysis were excluded from the study. All patients received 400 mg ofloxcacin daily for 20 days. After treatment the patients were reevaluated. Regardless of the total prostate specific antigen value after therapy transrectal ultrasound guided prostate biopsy was performed.
Overall 23 men (23%) had histologically proven prostate cancer on biopsy. Mean total prostate specific antigen, free prostate specific antigen and prostate specific antigen density decreased after treatment in patients with and without prostate cancer. However, these reductions within these parameters were not significantly different between patients with and without prostate cancer. Only percent free prostate specific antigen change after treatment was found to be significantly different between patients with and without prostate cancer (p = 0.015). In 17 of the 100 men total prostate specific antigen after treatment was less than 4 ng/ml and of these 5 (29.4%) had prostate cancer on biopsy.
Although antibiotic therapy will decrease serum total prostate specific antigen, it will not decrease the risk of prostate cancer even if the prostate specific antigen decreases to less than 4 ng/ml. Therefore, prescribing antibiotics for asymptomatic men with a newly increased prostate specific antigen may not be an appropriate method of management.
尽管围绕该主题存在争议，但一些泌尿外科医生在日常实践中经常在活检前给前列腺特异性抗原（PSA）新升高的男性开抗生素。我们评估了抗生素对PSA在4至10 ng/ml且直肠指检正常的男性血清总PSA、游离PSA、游离PSA百分比和PSA密度的影响。我们还通过对所有患者进行前列腺活检来调查抗生素治疗后前列腺癌的发生率，无论治疗后的PSA水平如何。
2006年5月至2008年4月，共有100名总PSA在4至10 ng/ml的男性纳入本研究。除总PSA外，还对所有患者的游离PSA、游离PSA百分比和PSA密度值进行了评估。直肠指检和尿液分析异常的患者被排除在研究之外。所有患者每天接受400 mg洛美沙星，共20天。治疗后对患者进行重新评估。无论治疗后的总PSA值如何，均进行经直肠超声引导下前列腺活检。
总体而言，23名男性（23%）活检组织学证实患有前列腺癌。治疗后，有和没有前列腺癌的患者的平均总PSA、游离PSA和PSA密度均下降。然而，有和没有前列腺癌的患者在这些参数上的下降没有显著差异。仅发现治疗后游离PSA百分比的变化在有和没有前列腺癌的患者之间有显著差异（p = 0.015）。100名男性中有17名治疗后的总PSA低于4 ng/ml，其中5名（29.4%）活检患有前列腺癌。
尽管抗生素治疗会降低血清总PSA，但即使PSA降至低于4 ng/ml，也不会降低前列腺癌风险。因此，给无症状且PSA新升高的男性开抗生素可能不是一种合适的处理方法。
