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.
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.
Authors: Ozgur Ugurlu; Mehmet Yaris; C Volkan Oztekin; T Murat Kosan; Oztug Adsan; Mesut Cetinkaya Journal: Urol Int Date: 2010-03-04 Impact factor: 2.089
Authors: Young Jung Kim; Sun-Ouck Kim; Kwang Ho Ryu; In Sang Hwang; Eu Chang Hwang; Kyung Jin Oh; Seung Il Jung; Taek Won Kang; Dong Deuk Kwon; Kwangsung Park; Soo Bang Ryu Journal: Korean J Urol Date: 2011-07-24