Abstract

Objectives: To compare PSA level in patients before and after four weeks of antibiotic therapy and to avoid unnecessary TRUS guided prostatic biopsies.

Study Design: Prospective cross-sectional

Place and Duration of Study: Urology Department, Shaikh Zayed Hospital Lahore from 1st January 2013 to 31st July 2013.

Materials and Methods: A total of 50 cases were included. Detailed history, general physical and systemic examination including digital rectal examination (DRE) was done. Urine was collected for routine examination, culture and sensitivity (C/S) after prostatic massage. The sample for serum PSA was collected before DRE and was analyzed by ELISA technique. If PSA level was raised > 4ng/ml then antibiotic therapy was given according to urine C/S. Those cases which showed no organism on C/S, empirically Tab. Ciprofloxacin 500mg BD PO was given for four weeks. Serum PSA level was repeated after completion of four weeks of antibiotic therapy. Transrectal ultrasonographic (TRUS) guided prostatic biopsy was performed in those cases, still having serum PSA level > 4ng/ml.

Results: Mean age of patients was 64.0 (45-85) years. Urine culture revealed no growth in 32 (64.0%) patients, while 18 (36%) showed variety of organisms on c/s. Out of 50, PSA level returned to normal in 26 (52.0%) patients, while no significant change in serum PSA level was observed in 24 (48.00%) patients. The non-responder patients underwent TRUS guided prostatic biopsy. Histopathology revealed moderately differentiated adenocarcinoma of the prostate in 5(10%) patients. Before treatment serum PSA level was 10.45+5.38 ng/ml after treatment PSA decreased to 5.47+4.49 ng/ml.

Conclusion: Antibiotics treatment for a period of minimum four weeks in patients with raised serum PSA level > 4ng/ml may reduce serum PSA level significantly. This may help us in avoiding un-necessary prostatic biopsies and related complications.

Keywords: Prostate-specific antigen, Prostatitis, Antibiotics