Kerem TEKE, Yavuz Onur DANACIOĞLU, Salih POLAT

PSA Yüksekliği Olan Hastalarda Ofloksasin Tedavisinin PSA Düşürücü Etkisini Öngörücü Parametreler

Giriş: Bu çalışmada ofloksasin tedavisinin PSA düşüşü üzerine olan etkinliğinin ve PSA düşüşünü öngören biyo-belirteçlerin belirlenmesi amaçlanmıştır. Çalışmamızda oflaksosin tedavisinin PSA (prostat spesifik antijen) üzerindeki düşürücü etkisini inceleyip, düşüşünü öngören parametreleri saptamayı amaçladık.Gereç ve Yöntemler: PSA değeri 4 ng/dl ve üzeri olan ve 15 günlük oflaksosin tedavisi verilerek kontrole gelen 99 hastanın kayıtları retrospektif olarak incelendi. Hastaların demografik, radyolojik ve laboratuvar verileri kaydedildi. Tedavi öncesi ve sonrası PSA değerindeki ortanca değişiklik kadar azalma gözlenmeyen veya artış olan hastalar Grup-1, ortanca değişiklik veya bu miktardan daha fazla azalmaya sahip olan hastalar Grup-2 olarak kategorize edildi. Bu iki grup arasındaki tedavi öncesi demografik veriler, radyolojik ve laboratuvar bulguları arasındaki farklar istatistiksel olarak değerlendirildi. İstatistiksel anlamlı çıkan parametreler için ROC analizi yapıldı. Bulgular: Çalışmamızda ofloksasin tedavisi sonrasında total PSA (tPSA), serbest PSA (sPSA), PSA dansitesi (PSAD) değerlerinde istatistiksel olarak anlamlı düşüş izlendi. tPSA’daki ortanca değişim -%27,9 olup (-%96,7 – +%101,4), %27,9 dan daha fazla düşüş gözlenmeyen Grup-1 (n=50)’e göre, %27.9 ve daha fazla miktarda tPSA düşüşü olan Grup 2 (n=49)’de tedavi öncesi laboratuvar parametrelerinden CRP, beyaz küre sayısı (BKS), tPSA ve kreatinin değerlerinin istatistiksel anlamlı olarak daha fazla olduğu bulundu (p<0,05). Radyolojik ve demografik verilerde ise üretral kateterizasyon (p=0,023) öyküsü dışında diğer parametreler için bir fark gözlenmedi. Yapılan ROC analizine göre oflaksosin’in PSA düşürücü etkisini öngörmede tPSA, PSAD, CRP, kreatinin, BKS için cut-off değerleri ise sırasıyla 9,66 ng/mL 0,10, 2,53 mg/dL, 0,94 mg/dL ve 7,60 103/uL olarak bulundu (p<0,05). Sonuç: Günlük ürolojik uygulamalarda PSA yüksekliği nedeniyle sıklıkla antibiyoterapi uygulanmaktadır. 2. Kuşak kinolon kullanımı ile sağlanan PSA düşürücü etkinin öngörülmesinde belirlediğimiz tPSA, PSAD, CRP, kreatinin, BKS tedavi izleminde kullanılabilecek parametreler olarak kabul edilebilir.

Anahtar Kelimeler:

Kronik prostatit, PSA, ofloksasin

Predictive Parameters on the Effect of Ofloxacin Treatment on the Reduction of PSA in Patients With Elevated PSA Level

Aim: To evaluate the effect of ofloxacin treatment on reduction of prostate spesific antigen (PSA) values and aimed to define the predictive biomarkers for PSA-decreasing after treatment. Materials and methods: All consecutive 99 outpatients patients with total PSA > 4 ng/ml and treated with ofloxacin for 15 days were retrospectively identified and evaluated for PSA response two weeks after the end of antibiotic therapy. The patient’s demographic, radiologic, and laboratory data were enrolled. After determination of median change of total prostate spesific antigen (tPSA), the patient cohort was categorized two groups as Group-1 (no reduction as more as in the median PSA value) and Group-2 (more reduction than the median PSA value). The differences of demographic, radiologic and laboratory data between the two groups were evaluated statistically. The ROC analysis was performed for statistically significant parameters.Results: tPSA, free PSA (fPSA), and PSA density (PSAD) were significantly decreased after the treatment. The median reduction of tPSA was -27,9% (range -%96,7 – +%101,4). The pretreatment parameters of C-reactive protein (CRP), white blood cells (WBC), tPSA, creatinine, PSAD values were observed higher in group 2 than group-1 (p<0,05). The findings on radiological and demographic of the groups were statistically similar for other parameters except urethral catheterization (p=0,023). According to the ROC analysis, the cut-off values for tPSA, PSAD, CRP, creatinine and WBC for predicting the PSA-decreasing effect of oflaxosin were 9,66 ng/mL, 0,10, 2,53 mg/dL, 0,94 mg/dL, and 7,60 103, respectively (p<0,05). Conclusion: Ampiric antibiotherapy is commonly applied in daily urologic practice due to the elevated of PSA levels. The predictive values of PSAD, CRP, creatinine and WBC for the PSA-decreasing effect following to use 2nd generation quinolone may be utilized the follow-up of the treatment.

Keywords:

Chronic prostatitis, PSA, ofloxacin,

PDF

___

1. Barry MJ, Simmons LH. Prevention of prostate cancer morbidity and mortality: primary prevention and early detection. Med Clin North Am 2017;101:787-806
2. Baltacı S, Süer E, Haliloğlu AH, Gokce Mİ, Elhan AH, Bedük Y. Effectiveness of antibiotics given to asymptomatic men for an increased prostate specific antigen. J Urol 2009;181:128-32
3. Grabe M, Bartoletti R, Bjerklund Johansen T. Guidelines on urological infections. European Association of Urology Web site. 2015
4. Nickel JC. Prostatitis. Can Urol Assoc J 2011;5:306
5. Kaygısız O, Uğurlu Ö, Koşan M, Inal G, Öztürk B, Cetinkaya M. Effects of antibacterial therapy on PSA change in the presence and absence of prostatic inflammation in patients with PSA levels between 4 and 10 ng/ml. Prostate Cancer Prostatic Dis 2006;9:235
6. Potts JM. Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate specific antigen. J Urol 2000;164:1550-3
7. Buddingh KT, Maatje MG, Putter H, Kropman RF, Pelger RC. Do antibiotics decrease prostate-specific antigen levels and reduce the need for prostate biopsy in type IV prostatitis? A systematic literature review. Can Urol Assoc J 2018;12:E25
8. Carver BS, Bozeman CB, Williams B, Venable DD. The prevalence of men with National Institutes of Health category IV prostatitis and association with serum prostate specific antigen. J Urol 2003;169:589-91
9. Simardi LH, Tobias-MacHado M, Kappaz GT, Goldenstein PT, Potts JM, Wroclawski ER. Influence of asymptomatic histologic prostatitis on serum prostate-specific antigen: a prospective study. Urology 2004;64:1098-101
10. Bozeman CB, Carver BS, Eastham JA, Venable DD. Treatment of chronic prostatitis lowers serum prostate specific antigen. J Urol 2002;167:1723-6
11. Stopiglia R, Ferreira U, Silva Jr M, Matheus W, Denardi F, Reis L. Prostate specific antigen decrease and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial. J Urol 2010;183:940-5
12. Karazanashvili G, Managadze L. Prostate–Specific Antigen (PSA) Value Change after Antibacterial Therapy of Prostate Inflammation, 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
13. Kehinde E, Sheikh M, Mojimoniyi O, Francis I, Anim J, Nkansa‐Dwamena D, et al. High serum prostate‐specific antigen levels in the absence of prostate cancer in Middle‐Eastern men: the clinician's dilemma. BJU Int 2003;91:618-22
14. DANACIOĞLU YO, Bülent E, ÇAŞKURLU T. Auxiliary tests in the diagnosis of prostate cancer Med Med J 2018;33:47-53
15. Yang L, Zhu Y, Tang Z, Chen Y, Gao L, Liu L, et al., editors. Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis. Urol Oncol: Seminars and Original Investigations; 2015: Elsevier
16. Cho IR, Chang YS, Roh JS, Jeon JS, Park SS. Change of PSA and PSAD after antibiotic treatment in patients with prostatitis. Korean J Androl. 2002;20:100-5.17. Edlin RS, Heyns CF, van Vuuren SP, Zarrabi AD. Prevalence of histological prostatitis in men with benign prostatic hyperplasia or adenocarcinoma of the prostate presenting without urinary retention. S Afr J Surg 2012;50:127-30
18. Atalay HA, Canat L, Alkan I, Çakir SS, Altunrende F. Prostate-specific antigen reduction after empiric antibiotic treatment does not rule out biopsy in patients with lower urinary tract symptoms: Prospective, controlled, single-center study. Prostate Int 2017;5:59-64
19. Akduman B, Akduman D, Tokgöz H, Erol B, Türker T, Ayoğlu F, et al. Long-term fluoroquinolone use before the prostate biopsy may increase the risk of sepsis caused by resistant microorganisms. Urol 2011;78:250-5
20. Feliciano J, Teper E, Ferrandino M, Macchia RJ, Blank W, Grunberger I, et al. The incidence of fluoroquinolone resistant infections after prostate biopsy—are fluoroquinolones still effective prophylaxis? J Urol 2008;179:952-5