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ABSTRACT: The aim of this study was to determine if antibiotic or anti-inflammatory medications lower serum prostate-specific antigen (PSA) in the presence or absence of inflammation in the prostatic secretions of patients with PSA levels between 2.5 and 10 ng/ml and normal digital rectal examinations (DRE).
Patients with PSA levels between 2.5 and 10 ng/ml and normal DRE were candidates for the study. One hundred and eight patients with positive expressed prostate secretion (EPS) were randomized into antibiotics, anti-inflammatory and control groups (groups 1, 2 and 3, respectively), and 108 patients with negative EPS were randomized into similar groups (groups 4, 5 and 6, respectively). Repeat PSA levels of all patients were obtained 6 weeks after randomization and 10 core prostate biopsies were performed.
Median PSA levels in group 1 before and after treatment were 5.2 (4.3-6.4) and 4.0 ng/ml (3.1-4.9), respectively (p < 0.001). The only significant decrease in PSA was observed in group 1. The percent change in PSA levels in group 1 was significantly greater than both in its control group (group 3; p < 0.001) and the EPS- antibiotics group (group 4; p < 0.001).
Antibiotherapy significantly reduces serum PSA only in EPS+ patients, which justifies limiting the use of prebiopsy antibiotics to EPS+ patients with a normal DRE and PSA level between 2.5 and 10 ng/ml, minimizing the major drawbacks of empirical antibiotics usage.
Urologia Internationalis 03/2010; 84(2):185-90. DOI:10.1159/000277596 · 1.43 Impact Factor
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ABSTRACT: To evaluate whether upgrading of the biopsy after radical prostatectomy (RP) affects disease outcome in terms of unfavorable pathology and biochemical failure.
We retrospectively evaluated the records of 174 patients who underwent RP. Prostate biopsy and RP specimen Gleason scores (GSs) and correlative clinical data were recorded, and a multivariate analysis was applied.
Overall (138 patients), the disease of 69 men (50.0%) was upgraded, in 19 (13.8%) it was downgraded, and in 50 (36.2%) it had an identical biopsy and pathological GS. Accuracy rates were significantly higher for GS 8-10 compared to low GSs, with a concordance of 50.0 and 12.2%, respectively (p < 0.01). Multivariate analysis revealed the single independent prognostic factor for a non-organ-confined disease as a RP GS 8-10 (p = 0.035). The factors associated with a positive surgical margin were a biopsy GS 8-10 (p < 0.001) and the presence of biopsy score upgrading (p = 0.02). Biopsy GS >or=8 (p < 0.001) and presence of biopsy score upgrading (p = 0.009) were the two independent predictors of relapse after RP.
This study demonstrated that biopsy upgrading was present in almost half of the patients who underwent RP and it was significantly related to positive surgical margins and biochemical relapse after RP.
Urologia Internationalis 09/2009; 83(2):146-50. DOI:10.1159/000230014 · 1.43 Impact Factor
European Urology Supplements 03/2009; 8(4):235-235. DOI:10.1016/S1569-9056(09)60457-7 · 3.37 Impact Factor
The Journal of Urology 04/2008; 7(3):139-139. DOI:10.1016/S1569-9056(08)60273-0 · 4.47 Impact Factor