Role of antibiotic therapy in preventing unnecessary prostate biopsy in patients with psa levels 4-10 ng/ml with normal dre

Dhanasekaran D., Karunamoorthy R., Prakash JVS and Ilamparuthi C

Objectives- To evaluate the role of antibiotic treatment in preventing unnecessary prostate biopsy in patients with PSA level 4-10 ng/ml with normal DRE.

Methods- The study was a prospective randomized open-label trial including 54 patients divided into study group (29 patients) and control group (25 patients) done in the Institute of Urology, Madras Medical College, Chennai from September 2014 to April 2016.Study Group patients were given ciprofloxacin 500 mg twice daily for 3 weeks. PSA repeated. Patients again divided into 2 groups- PSA < 4ng/ml and PSA >4 ng/ml. Standard 12-core biopsy was done in all patients. Percentage of patients positive for malignancy were observed and analyzed in both groups. Control Grouppatients received multivitamin capsules for 3 weeks. Rest of the procedure was same as study group.

Results- 13 of 29 patients (44.8%) in study group and 4 of 25 patients (16%) in control group had decrease in PSA level below 4ng/ml. Among the study group patients, cancer was found in only 1 of 13 patients (7.6%) whose repeat PSA was below 4ng/ml whereas cancer was diagnosed in 7 of 16 patients (43.7%) whose repeat PSA was above 4ng/ml.

Conclusion- 3 weeks of ciprofloxacin treatment significantly decreases PSA in patients with levels between 4-10 ng/ml. Biopsy can be avoided in patients with repeat PSA<4ng/ml after antibiotic treatment. Larger randomized blinded control trials are required for arriving at a definitive conclusion.

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