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Does antibiotic treatment for elevated PSA help avoid biopsy of prostate?

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Is it true that antibiotic treatment of an acutely elevated PSA test in a 74 year old male, with BPH, can help avoid biopsy of prostate if the PSA drops siginificantly after a three week course of antibiotic treatment ?
Posted Thu, 20 Feb 2014 in Urinary and Bladder Problems
 
 
Answered by Dr. Manuel C See IV 39 minutes later
Brief Answer: Yes a trial of antibx might cause a drop in PSA. Detailed Answer: Good Day and thank you for being with Healthcare Magic! PSA can be elevated due to prostate cancer, prostate inflammation and prostate infection. It is common practice to do a trial of antibiotics for PSA level on the grey zone (4-10ng/mL) on patients with abnormal urinalysis or with voiding symptoms (urinary frequency, urgency etc.). This basically rules out prostatitis as a cause of the elevated PSA thereby negating the need for a prostate biopsy if the PSA goes back to normal. If there is no change in the serum PSA then a TRUS prostate biopsy can be offerred to the patient. There is one recent study though that showed that on men with elevated PSA then the PSA decreased after two weeks of antibiotics, 15% of these men were biopsied and showed prostate cancer even though their PSA decreased down but not to normal levels. A lot of factors regarding PSA should be taken into consideration like PSA velocity (how high does PSA increase after 6 months), PSA density (PSA divided by the estimated prostate gland weight) and not by the absolute value of the PSA. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: WWW.WWWW.WW I would gladly help you. Best wishes. Regards, Manuel C. See IV, M.D. DPBU FPUA
Above answer was peer-reviewed by
 
Follow-up: Does antibiotic treatment for elevated PSA help avoid biopsy of prostate? 13 minutes later
How long on Cipro is recommended before re- testing ? I had a 17 score that went down to 9 within 5 days. My prostate was enlarged on one side. Have urgency and frequency sx, My PCP recommended a month on Cipro. The urologist I saw said not to bother and get another test after a week. What to do ?
 
 
Answered by Dr. Manuel C See IV 4 hours later
Brief Answer: It's your decision in the end. Detailed Answer: Good Day and thank you for being with Healthcare Magic! You may try doing what your PCP suggested and continue ciprofloxacin for one month then repeat the serum PSA. Treatment for prostate infection needs one month of antibiotic therapy since the prostate is very hard to penetrate. Then after one month you repeat serum PSA and get a free and total PSA examination then if it is still elevated then you may get the TRUS biopsy of the prostate. Or you may get the TRUS biopsy now then get it over with. PSA is just a screening test and only 1/3 men with elevated PSA is harboring prostate cancer. Biopsy will be only thing that we have that can tell if you have prostate cancer or not. One month delay would really not matter since prostate cancer (in case you have one) is an indolent and slow growing disease. If I was your doctor I would side with the PCP and get the free and total PSA after a month of ciprofloxacin. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: WWW.WWWW.WW I would gladly help you. Best wishes. Regards, Manuel C. See IV, M.D. DPBU FPUA
Above answer was peer-reviewed by
 
Follow-up: Does antibiotic treatment for elevated PSA help avoid biopsy of prostate? 2 hours later
I was thinking of getting the PSA test redone now and continue taking the Cipro with another retest in three weeks. Does that sound reasonable? Also have you heard of biopsies that are done under MRI
 
 
Answered by Dr. Manuel C See IV 9 hours later
Brief Answer: Either PSA after one month of ABX or do TRUS now. Detailed Answer: Good Day and thank you for being with Healthcare Magic! I am sorry but I don't see the reason why do a serum PSA now then repeat it after one month of ciprofloxacin. It is either you do the serum PSA after one month or just do the TRUS prostate biopsy now. MRI guided prostate biopsies are not routinely done but are useful for prostate cancer in the anterior part of the prostate gland which is not reached by a regular ultrasound guided prostate biopsy. Anterior tumors are uncommon and MRI guided biopsies are done after multiple negative TRUS guided prostate biopsy with persistent elevated serum PSA. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: WWW.WWWW.WW I would gladly help you. Best wishes.
Above answer was peer-reviewed by
 
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