Do antibiotics decrease prostate-specific antigen levels and reduce the need for prostate biopsy in type IV
Karel T Buddingh1, Marlies G F Maatje2, Hein Putter1
1Department of Urology, Leiden University Medical Centre, Leiden; Netherlands.
Introduction:
Inflammation of the prostate can be a cause of elevated prostate-specific antigen (PSA) in men referred for suspected prostate cancer. This systematic review assesses the evidence for antibiotic therapy in patients with type IV (asymptomatic) prostatitis with regard to reduction of PSA levels and discrimination between prostate cancer and inflammation.
Methods:
MEDLINE, EMBASE, and the Cochrane registry were searched for papers reporting on cohorts of men with elevated PSA and type IV prostatitis that were treated with antibiotics.
Results:
The search yielded 160 papers, of which 11 met the inclusion criteria: two randomized trials and nine cohort studies. In total, the studies reported on 1011 patients with type IV prostatitis, of whom 926 were treated with antibiotics. PSA normalization was seen after antibiotic treatment in 33.2% of patients (95% confidence interval [CI] 24.9-42.8). Meta-analysis of the randomized trials did not demonstrate a higher likelihood of PSA normalization in the antibiotics arm as compared to the control arm (odds ratio [OR] 1.27; 95% CI 0.58-2.76; p=0.553). Four studies performed prostate biopsies in all patients. Although three of these studies demonstrated lower prevalence of prostate cancer in patients in whom PSA had normalized, meta-analysis failed to show a statistically significant difference (OR 0.39; 95% CI 0.06-2.49; p=0.319).
Conclusions:
The available evidence does not support antibiotic therapy for differentiation between benign and malignant cause of elevated PSA in men with type IV prostatitis.
Insights
Antibiotic therapy for asymptomatic prostatitis (type IV) does not reliably reduce elevated prostate-specific antigen (PSA) levels. This review found no significant evidence that antibiotics help distinguish prostate cancer from inflammation in men with high PSA.
Area of Science:
- Urology
- Oncology
- Infectious Diseases
Background:
- Elevated prostate-specific antigen (PSA) can indicate prostate cancer or inflammation.
- Type IV prostatitis (asymptomatic prostatitis) is a potential cause of elevated PSA.
Purpose of the Study:
- To assess the effectiveness of antibiotic therapy in reducing PSA levels in men with type IV prostatitis.
- To evaluate if antibiotic treatment aids in differentiating prostate cancer from inflammation.
Main Methods:
- Systematic review of MEDLINE, EMBASE, and Cochrane registry.
- Included studies reported on men with elevated PSA and type IV prostatitis treated with antibiotics.
- Meta-analysis of randomized trials and cohort studies.
Main Results:
- 11 studies (1011 patients) met inclusion criteria; 926 received antibiotics.
- PSA normalization occurred in 33.2% of patients after antibiotic treatment.
- Meta-analysis showed no significant difference in PSA normalization between antibiotic and control groups (OR 1.27).
- No statistically significant difference in prostate cancer prevalence was found between patients with normalized PSA and those without.
Conclusions:
- Current evidence does not support using antibiotic therapy to differentiate between benign and malignant causes of elevated PSA in men with type IV prostatitis.
- Further research may be needed to clarify the role of antibiotics in managing elevated PSA.
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