The Effect of the Treatment of Prostatitis on the Serum Prostate Specific Antigen Levels and the Frequency of Prostatic Biopsies

Rho, Tae Hyung; Lee, Jeong Gu; Nam, Sam Keuk

Abstract

PURPOSE: We attempted to identify the prostatitis in men with elevated serum prostate specific antigen (PSA) levels, and also determined whether treatment with antibiotics lowers serum PSA, resulting in decreases of the frequency of prostatic biopsies.
MATERIALS AND METHODS
Men with lower urinary tract symptoms, and serum PSA greater than 4ng/ml, were evaluated for the presence of prostatitis. Prostatitis was defined as over 20 white blood cells in expressed prostatic secretions. Patients with prostatitis were treated with a 4-week course of antibiotics. Patient without signs of prostatitis underwent transrectal biopsies. PSA blood tests and prostatic massages were repeated 4 weeks later. Patients with PSA levels greater than 25ng/ml were excluded.
RESULTS
Of the 49 patients with elevated PSA levels (with a mean PSA level of 9.26ng/ml), 29 (59%) had the laboratory signs of prostatitis. In 18 patients (62%) with prostatitis, the serum PSA level decreased to below 4ng/ml (mean 2.73ng/ml) after treatment. The remaining 11 patients with prostatitis, and the 20 patients without, underwent sextant transrectal ultrasound guided biopsies; which resulted in pathologic confirmation of prostate cancer in 3 out of the 11 patients with prostatitis, and in 4 (20%) out of the 20 patients without. Screening for prostatitis decreased the frequency of a prostatic biopsy by 32.7%.
CONCLUSIONS
In over half of the patients with elevated serum PSA levels, the clinical evaluation revealed evidence of prostatitis. The treatment of prostatitis in this study decreased prostate biopsies by 32.7%. We suggest that screening for prostatitis in patients with elevated PSA levels, and it subsequent treatment can decrease the percentage of negative biopsies.