Department of Urology, Sakarya Yenikent State Hospital, Sakarya, Turkey.
Department of Urology, Faculty of Medicine, Koç University, İstanbul, Turkey.
Turk J Med Sci. 2023 Feb;53(1):183-192. doi: 10.55730/1300-0144.5571. Epub 2023 Feb 22.
To investigate the effect of antibiotic treatment on PSA when deciding on prostate biopsy.
A total of 206 patients with an elevated PSA level (2.5-30) were included. Mp-MRI could be done on 129 patients. Patients were given ciprofloxacin (500 mg, b.i.d. p.o.) for 4 weeks and PSA measurements were repeated. Systematic prostate biopsy was performed regardless of PSA changes on all patients. Additionally, cognitive biopsies were performed from PI-RADs III, IV, and V lesions.
: Prostate cancer was detected in 36.4% of patients. 53.3% had Gleason score of 3+3, 46.7% had Gleason score ≥ 3+4. PSA values decreased in 56.3% and in 43.7% and remained the same or increased but cancer detection rates were not different: 34.5% vs. 38.9%, respectively (p = 0.514). PSA change in whole group was significant (6.38 ng/mL vs. 5.95 ng/mL, respectively (p = 0.01). No significant PSA decrease was observed in cancer patients (7.1 ng/mL vs. 7.05 ng/mL, p = 0.09), whereas PSA decrease was significant in patients with benign pathology (6.1 ng/mL vs. 5.5 ng/mL, p = 0.01). In patients with PI-RADs IV-V lesions, adenocarcinoma was present in 33.9% and 30.4% with or without PSA decrease, respectively (p = 0.209). Clinically significant cancer was higher in patients with after antibiotherapy PSA values >4 ng/mL regardless of PI-RADs grouping (p = 0.08). Addition of any PSA value to PI-RADs grouping did not have any significant effect on the detection of cancer.
PSA change after antibiotic treatment has no effect in detecting cancer and should not delay performing a biopsy.
研究抗生素治疗对前列腺活检时 PSA 决策的影响。
共纳入 206 例 PSA 水平升高（2.5-30）的患者。129 例患者可行 mp-MRI。所有患者均给予环丙沙星（500mg，bid po）治疗 4 周，并重复 PSA 测量。所有患者均进行系统前列腺活检，无论 PSA 变化如何。此外，对 PI-RADS III、IV 和 V 病变进行认知活检。
患者中检出前列腺癌 36.4%。Gleason 评分 3+3 占 53.3%，Gleason 评分≥3+4 占 46.7%。56.3%的 PSA 值下降，43.7%的 PSA 值不变或增加，但癌症检出率无差异：34.5%vs.38.9%（p=0.514）。全组 PSA 变化有统计学意义（分别为 6.38ng/ml 和 5.95ng/ml，p=0.01）。癌症患者 PSA 无显著下降（7.1ng/ml 和 7.05ng/ml，p=0.09），而良性病理患者 PSA 显著下降（6.1ng/ml 和 5.5ng/ml，p=0.01）。在 PI-RADS IV-V 病变患者中，PSA 下降组和未下降组腺癌分别为 33.9%和 30.4%（p=0.209）。无论 PI-RADS 分组如何，抗生素治疗后 PSA 值>4ng/ml 的患者中临床显著癌症更高（p=0.08）。将任何 PSA 值添加到 PI-RADS 分组中对癌症的检测均无显著影响。
抗生素治疗后 PSA 变化对癌症检测无影响，不应延迟进行活检。
