Yang Lu, Zhu Yuchun, Tang Zhuang, Chen Yongji, Gao Liang, Liu Liangren, Han Ping, Li Xiang, Wei Qiang
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Urol Oncol. 2015 May;33(5):201.e17-24. doi: 10.1016/j.urolonc.2015.02.001. Epub 2015 Mar 7.
To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs).
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.
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).
The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs.
评估经验性使用抗生素对降低前列腺特异性抗原（PSA）水平的效果以及避免不必要前列腺活检（PB）的可能性。
对PubMed、Embase和Cochrane图书馆进行系统检索，以确定所有比较经验性使用抗生素与不治疗或安慰剂对降低PSA水平及减少PSA水平中度升高患者不必要PB效果的随机对照试验（RCT）。使用Cochrane协作网Review Manager软件（RevMan 5.1.4）进行统计分析。
6项RCT（1项安慰剂对照和5项不治疗对照）纳入656例患者，符合本研究纳入标准。这些RCT的综合数据表明，治疗后抗生素组与对照组在PSA水平（平均差[MD]=0.15，95%可信区间：-0.50至0.81，P=0.65）、治疗后PSA水平降低的患者数量（相对危险度[RR]=1.22，95%可信区间：0.90 - 1.65，P=0.20）、治疗后前列腺特异性抗原密度水平（MD=-0.04，95%可信区间：-0.15至0.07，P=0.47）、治疗后f/t% PSA（MD=-1.47，95%可信区间：-4.65至1.71，P=0.37）、PSA反应性患者数量（RR=1.02，95%可信区间：0.58 - 1.81，P=0.94）以及这些患者中个体前列腺癌阳性率（RR=1.07，95%可信区间：0.53 - 2.16，P=0.86）和前列腺癌阳性率（RR=0.85，95%可信区间：0.48 - 1.50，P=0.57）方面无显著差异。然而，与对照组相比，抗生素组治疗后净PSA降低有显著变化（MD=1.44，95%可信区间：0.70至2.17，P=0.0001）。
经验性使用抗生素可能不会显著降低PSA水平或避免不必要的PB。
