Akif KOÇ, Ersin ÇİMENTEPE, Doğan ÜNAL, Ömer Faruk KARATAŞ

3517

Ciprofloxacin versus levofloxacin in avoidance of prostate biopsy in patients with isolated PSA elevation: a prospective randomized study

The efficiencies of ciprofloxacin and levofloxacin on prostate-specific antigen (PSA) elevation were compared in terms of avoidance of prostate biopsy in this study. Materials and methods: Included in the study were 43 men with PSA levels of >=3.5 ng/mL. They were randomized into either ciprofloxacin or levofloxacin groups for a 3-week course. PSA and free PSA levels were measured before and after the antibiotherapy. The patients in whom PSA remained >=3.5 ng/mL after therapy underwent biopsy. Results: The average age of the men was 64.44 years (standard deviation: 9.54). Following antibiotics, 76.7% of the patients showed a reduction in PSA and 32.6% showed PSA normalization; PSA levels dropped by a rate of 27.1% (P < 0.001). In the ciprofloxacin group, the PSA reduction rate and PSA normalization were insignificantly higher than in the levofloxacin group. Ciprofloxacin caused a significant reduction in PSA (-41.6% change, P < 0.001), but levofloxacin did not (-5.6% change). With quinolones, positive predictive value improved from 9.3% to 13.8%. Of the 29 patients with persistent PSA levels of >=3.5 ng/mL after antibiotics, 4 were diagnosed with prostate cancer (13.8%). Conclusion: Empirical ciprofloxacin seems to be more effective than levofloxacin in men with isolated PSA elevation, leading to the avoidance of unnecessary prostate biopsy in nearly half of the cases, and enhances diagnostic capabilities of both PSA and prostate biopsy.
Anahtar Kelimeler:

Key words: Ciprofloxacin, levofloxacin, prostate cancer, prostate-specific antigen

Ciprofloxacin versus levofloxacin in avoidance of prostate biopsy in patients with isolated PSA elevation: a prospective randomized study

The efficiencies of ciprofloxacin and levofloxacin on prostate-specific antigen (PSA) elevation were compared in terms of avoidance of prostate biopsy in this study. Materials and methods: Included in the study were 43 men with PSA levels of >=3.5 ng/mL. They were randomized into either ciprofloxacin or levofloxacin groups for a 3-week course. PSA and free PSA levels were measured before and after the antibiotherapy. The patients in whom PSA remained >=3.5 ng/mL after therapy underwent biopsy. Results: The average age of the men was 64.44 years (standard deviation: 9.54). Following antibiotics, 76.7% of the patients showed a reduction in PSA and 32.6% showed PSA normalization; PSA levels dropped by a rate of 27.1% (P < 0.001). In the ciprofloxacin group, the PSA reduction rate and PSA normalization were insignificantly higher than in the levofloxacin group. Ciprofloxacin caused a significant reduction in PSA (-41.6% change, P < 0.001), but levofloxacin did not (-5.6% change). With quinolones, positive predictive value improved from 9.3% to 13.8%. Of the 29 patients with persistent PSA levels of >=3.5 ng/mL after antibiotics, 4 were diagnosed with prostate cancer (13.8%). Conclusion: Empirical ciprofloxacin seems to be more effective than levofloxacin in men with isolated PSA elevation, leading to the avoidance of unnecessary prostate biopsy in nearly half of the cases, and enhances diagnostic capabilities of both PSA and prostate biopsy.
Keywords:

Key words: Ciprofloxacin, levofloxacin, prostate cancer, prostate-specific antigen,

PDF

___

  • Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58: 71-96.
  • Unal D, Sedelaar JP, Aarnink RG, Van Leenders GJ, Wijkstra H, Debruyne FM et al. Th ree-dimensional contrast-enhanced power Doppler ultrasonography and conventional examination methods: the value of diagnostic predictors of prostate cancer. BJU Int 2000; 86: 58-64.
  • Kawakami J, Siemens DR, Nickel JC. Prostatitis and prostate cancer: implications for prostate cancer screening. Urology 2004; 64: 1075-80. 4. Hochreiter WW. Th e issue of prostate cancer evaluation in men with elevated prostate-specifi c antigen and chronic prostatitis. Andrologia 2008; 40: 130-3.
  • Schaeff er AJ, Wu SC, Tennenberg AM, Kahn JB. Treatment of chronic bacterial prostatitis with levofl oxacin and ciprofl oxacin lowers serum prostate specifi c antigen. J Urol 2005; 174: 161-4.
  • Gümüş BH, Neşe N, Gündüz MI, Kandiloğlu AR, Ceylan Y, Büyüksu C. Does asymptomatic infl ammation increase PSA? A histopathological study comparing benign and malignant tissue biopsy specimens. Int Urol Nephrol 2004; 36: 549-53.
  • Kwak C, Ku JH, Kim T, Park DW, Choi KY, Lee E et al. Eff ect of subclinical prostatic infl ammation on serum PSA levels in men with clinically undetectable prostate cancer. Urology 2003; 62: 854-9. 8. Kaygisiz O, Uğurlu O, Koşan M, Inal G, Oztürk B, Cetinkaya M. Eff ects of antibacterial therapy on PSA change in the presence and absence of prostatic infl ammation in patients with PSA levels between 4 and 10 ng/ml. Prostate Cancer Prostatic Dis 2006; 9: 235-8.
  • Serretta V, Catanese A, Daricello G, Liotta R, Allegro R, Martorana A et al. PSA reduction (aft er antibiotics) permits to avoid or postpone prostate biopsy in selected patients. Prostate Cancer Prostatic Dis 2008; 11: 148-52.
  • Chang SG, Kim CS, Jeon SH, Kim YW, Choi BY. Is chronic infl ammatory change in the prostate the major cause of rising serum prostate-specifi c antigen in patients with clinical suspicion of prostate cancer? Int J Urol 2006; 13: 122-6.
  • Potts JM. Prospective identifi cation of National Institutes of Health category IV prostatitis in men with elevated prostate specifi c antigen. J Urol 2000; 164: 1550-3.
  • Weidner W, Anderson RU. Evaluation of acute and chronic bacterial prostatitis and diagnostic management of chronic prostatitis/chronic pelvic pain syndrome with special reference to infection/infl ammation. Int J Antimicrob Agents 2008; 31: S91-5.
  • Nickel JC, Alexander RB, Schaeff er AJ, Landis JR, Knauss JS, Propert KJ. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol 2003; 170: 818-22.
  • Erol H, Beder N, Calişkan T, Dündar M, Unsal A, Culhaci N. Can the eff ect of antibiotherapy and anti-infl ammatory therapy on serum PSA levels discriminate between benign and malign prostatic pathologies? Urol Int 2006; 76: 20-6.
  • Carver BS, Bozeman CB, Williams BJ, Venable DD. Th e prevalence of men with National Institutes of Health category IV prostatitis and association with serum prostate specifi c antigen. J Urol 2003; 169: 589-91.
  • Karazanashvili G, Managadze L. Prostate-specifi c antigen (PSA) value change aft er antibacterial therapy of prostate infl ammation, as a diagnostic method for prostate cancer screening in cases of PSA value within 4–10 ng/ml and nonsuspicious results of digital rectal examination. Eur Urol 2001; 39: 538-43.
  • Dirim A, Tekin MI, Koyluoglu E, Oguzulgen AI, Peskircioglu L, Ozkardes H. Do changes in a high serum prostate-specifi c antigen level and the free/total prostate-specifi c antigen ratio aft er antibiotic treatment rule out biopsy and the suspicion of cancer? Urol Int 2009; 82: 266-9.
  • Kobayashi M, Nukui A, Morita T. Serum PSA and percent free PSA value changes aft er antibiotic treatment. A diagnostic method in prostate cancer suspects with asymptomatic prostatitis. Urol Int 2008; 80: 186-92.
  • Bozeman CB, Carver BS, Eastham JA, Venable DD. Treatment of chronic prostatitis lowers serum prostate specifi c antigen. J Urol 2002; 167: 1723-6.
  • Bundrick W, Heron SP, Ray P, Schiff WM, Tennenberg AM, Wiesinger BA et al. Levofl oxacin versus ciprofl oxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology 2003; 62: 537-41.
  • Ozden C, Ozdal OL, Guzel O, Han O, Seckin S, Memis A. Th e correlation between serum prostate specifi c antigen levels and asymptomatic infl ammatory prostatitis. Int Urol Nephrol 2007; 39: 859-63.
  • Kwak C, Ku JH, Kim T, Park DW, Choi KY, Lee E et al. Eff ect of subclinical prostatic infl ammation on serum PSA levels in men with clinically undetectable prostate cancer. Urology 2003; 62: 854-9.
  • Nadler RB, Collins MM, Propert KJ, Mikolajczyk SD, Knauss JS, Landis JR et al. Prostate-specifi c antigen test in diagnostic evaluation of chronic prostatitis/chronic pelvic pain syndrome. Urology 2006; 67: 337-42.
  • Stancik I, Lüft enegger W, Klimpfi nger M, Müller MM, Hoeltl W. Eff ect of NIH-IV prostatitis on free and free-to-total PSA. Eur Urol 2004; 46: 760-4.
  • Heidenreich A, Bolla M, Joniau S, Mason MD, Matveev V, Mottet N et al. Guidelines on prostate cancer. Arnhem, the Netherlands: European Association of Urology; 2010.
  • Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, Flanigan RC et al. Comparison of digital rectal examination and serum prostate specifi c antigen in the early detection of prostate cancer: result of a multicenter clinical trial of 6630 men. J Urol 1994; 151: 1283-90.
  • Propert KJ, Litwin MS, Wang Y, Alexander RB, Calhoun E, Nickel JC et al. Responsiveness of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Qual Life Res 2006; 15: 299-305.
  • Simardi LH, Tobias-MacHado M, Kappaz GT, Taschner Goldenstein P, Potts JM, Wroclawski ER. Infl uence of asymptomatic histologic prostatitis on serum prostate-specifi c antigen: a prospective study. Urology 2004; 64: 1098-101.
  • Loeb S, Gashti SN, Catalona WJ. Exclusion of infl ammation in the diff erential diagnosis of an elevated prostate-specifi c antigen (PSA). Urol Oncol 2009; 27: 64-6.
  • Magri V, Trinchieri A, Montanari E, Del Nero A, Mangiarotti B, Zirpoli P et al. Reduction of PSA values by combination pharmacological therapy in patients with chronic prostatitis: implications for prostate cancer detection. Arch Ital Urol Androl 2007; 79: 84-92.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Arşiv
Sayıdaki Diğer Makaleler

Plasma levels of IL-6 and TNF-α in patients with esophageal cancer

Atila EROĞLU, Atila TÜRKYILMAZ, Fatma GENÇ, Yusuf BİLEN, Yener AYDIN, Çağlar BULUT, İbrahim KAPLAN

Effects of L-2-ox&#1086;thiazolidine-4-carboxylic acid on the lung antioxidant defense system in an asthma mouse model

Lyudmil GEORGIEV TERZIEV, Veneta LYUBENOVA SHOPOVA, Violeta YORDANOVA DANCHEVA, Galya TZVETANOVA STAVREVA, Angelina MILCHEVA STOYANOVA

Effects of Ankaferd hemostat on the synovial fluid of patients with osteoarthritis

Mehmet Derya DEMİRAĞ, Mehmet Akif ÖZTÜRK, Zeliha TUFAN KOÇAK, İbrahim Celalettin HAZNEDAROĞLU

Effects of L-2-oxоthiazolidine-4-carboxylic acid on the lung antioxidant defense system in an asthma mouse model

Lyudmil TERZIEV GEORGIEV, Veneta SHOPOVA LYUBENOVA, Violeta DANCHEVA YORDANOVA, Galya STAVREVA TZVETANOVA, Angelina STOYANOVA MILCHEVA

Plasma levels of IL-6 and TNF-a in patients with esophageal cancer

Yener AYDIN, İbrahim KAPLAN, Yusuf BİLEN, Çağlar BULUT, Fatma GENÇ, Atila TÜRKYILMAZ, Atila EROĞLU

Dysregulation of nitric oxide synthase activity and Bcl-2 and caspase-3 gene expressions in renal tissue of streptozotocin-induced diabetic rats

Buket KOSOVA, Vildan ÇETİNTAŞ BOZOK, Hüseyin AKTUĞ, Şirin DEMİRAY BAKTI, Türker ÇAVUŞOĞLU, Saadet Özen AKARCA, Fatih OLTULU, Altuğ YAVAŞOĞLU

Limb remote ischemic postconditioning is effective but also time-course-limited in protecting the brain from I/R injury

Chenju YI, Haidong GUO, Qiangqiang LIU, Li WANG, Hongxia LI, Ce XU

Transient bradycardia in patients with Crimean-Congo hemorrhagic fever

Kemalettin ÖZDEN, Zülal ÖZKURT, Mustafa Kemal EROL, Serpil EROL, Mehmet PARLAK

Evaluation of vitamin B-12 level in middle-aged obese women with metabolic and non-metabolic syndrome: case-control study

Davut BALTACI, Ali KUTLUCAN, Serkan ÖZTÜRK, İsmail KARABULUT, Hayriye AK YILDIRIM, Ahmet ÇELER, Gökhan CELBEK, İsmail Hamdi KARA

Final baricity of ropivacaine or bupivacaine combined with fentanyl for intrathecal administration

Seval İZDEŞ, İrfan GÜNGÖR, Berrin GÜNAYDIN