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Prostate biopsies often unnecessary

SHREVEPORT, LOUISIANA. It is common practice to perform a biopsy of the prostate on men whose PSA (prostate specific antigen) level exceeds 4.0 ng/mL. The results of the biopsy, which is expensive, uncomfortable and anxiety-provoking, are negative in most cases (65 to 85 per cent negative) indicating that no cancer is present. Urologists at the Louisiana State University point out that acute prostatitis (inflammation of the prostate gland) and benign prostatic hypertrophy (enlarged prostate) can also give high PSA readings. They now report on a just completed trial designed to determine if men with chronic prostatitis also have high readings and if so, how often these abnormal readings actually are an indication of prostate cancer.

Their trial involved 95 men who had been diagnosed with chronic prostatitis and who had an elevated PSA level (average of 8.48 ng/mL), but no abnormalities in digital rectal examination. The men were all assigned to a four-week course of antibiotics (fluoroquinolones or doxycycline) and anti-inflammatories (ibuprofen or celecoxib). At the end of the four weeks 44 of the men (46.3 per cent) had a PSA level of less than 4 ng/mL (mean of 2.48 ng/mL) and were deemed to be free of prostate cancer. The remaining 51 men underwent double sextant transrectal ultrasound guided biopsy. Thirteen patients (25.5 per cent) were found to have prostate cancer, 37 (72.5 per cent) had chronic inflammation, and one patient had an enlarged prostate. The researchers conclude that treatment of chronic prostatitis in men with high PSA levels can substantially reduce the need for biopsies. It is of interest to note that the PSA levels in the men eventually diagnosed with prostate cancer only declined from an average of 8.32 to 7.92 ng/mL after four weeks of antibiotic therapy. Editor's Note: The moral of this story is that one should always ensure that one does not have acute or chronic prostatitis before submitting to a prostate biopsy.
Bozeman, Caleb B., et al. Treatment of chronic prostatitis lowers serum prostate specific antigen, Journal of Urology, Vol. 167, April 2002, pp. 1723-26

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