Empiric antibiotics for an elevated prostate-specific antigen (PSA) level: a randomised, prospective, controlled...

Area of Science:

• Urology
• Oncology
• Pharmacology

Background:

• Elevated prostate-specific antigen (PSA) levels often prompt prostate biopsy.
• The impact of empiric antibiotic use on PSA levels in men without infection is not well-established.

Purpose of the Study:

• To evaluate the effect of empiric antibiotic administration on PSA levels in men with elevated PSA undergoing prostate biopsy.

Main Methods:

• A randomized controlled trial involving men with PSA >2.5 ng/mL and normal digital rectal examination.
• Participants received either 2 weeks of ciprofloxacin or no antibiotic before prostate biopsy.
• PSA levels were measured at baseline and immediately prior to biopsy.

Main Results:

• Empiric ciprofloxacin use did not result in a statistically significant change in PSA levels compared to controls.
• Prostate cancer detection rates were lower in the antibiotic group (34%) versus the control group (59%), though this was not the primary endpoint.
• The study was stopped early due to poor patient accrual and an interim futility analysis.

Conclusions:

• Empiric antibiotic use in asymptomatic men with elevated PSA levels does not appear to offer clinical benefit.
• Further research may be needed to explore antibiotic effects on PSA, but current evidence suggests no significant impact.