Empiric Antibiotics for Elevated PSA of No Clinical Benefit
SAN FRANCISCO—New findings presented here at the annual Genitourinary Cancers Symposium challenge the widespread practice of placing patients on an empiric course of antibiotics for a newly elevated PSA level.
Scott E. Eggener, MD, of the University of Chicago, and colleagues studied 77 men with a newly elevated PSA level. Of these, 38 were randomized to receive ciprofloxacin 500 mg twice daily for two weeks or no antibiotic (control group). PSA was measured 21-45 days following randomization and immediately prior to prostate biopsy.
Prostate biopsy revealed prostate cancer in 36 men (47%). Detections rates did not differ significantly between patients with an increasing PSA or decreasing PSA between the two measurements, said Michael Christopher Large, MD, a urologic oncology fellow at the University of Chicago, who presented study findings. Mean PSA levels at randomization into the study were 7.6 ng/mL in the antibiotic group and 6.5 ng/mL in the control arm. The mean PSA levels at biopsy were 8.5 and 6.9 ng/mL, respectively.
In the antibiotic group, cancer was found after a PSA increase in seven (44%) of 16 patients after a PSA decrease in five (24%) of 21 patients. In the control arm, cancer was found after a PSA increase in 12 (60%) of 20 patients and after a PSA decrease in 11 (58%) of 19 patients.
“Prescription of empiric antibiotics in asymptomatic men with elevated PSA is not of any clinical benefit,” Dr. Large said.
The symposium is co-sponsored by the American Society of Clinical Oncology, the American Society of Radiation Oncology, and the Society of Urologic Oncology.