A question I saw on a prostate cancer forum:
My urologist has prescribed me cipro to take for a month and then get re tested for a rising psa score. it is currently 5.8 and i had a radical in 2003. my psa has been steadily rising over the past 7 years. i apparently have rogue cancer cells in my prostate bed. has anyone on the panel been prescribed cipro for a rising psa level?
This question is a variation of a theme. What do you think the right answer is?
Before the diagnosis of prostate cancer is known to be present or not…prescribing Cipro ( an antibiotic that is “good for what ails the prostate” ) is a reasonable thing to do for a high PSA. The thinking is that often times the PSA can go up in the face of prostatic inflammation. Cipro helps with that so often times the PSA will decrease and the doctor will not act on the elevated PSA if it reverts to normal. If not, the doctor proceeds to biopsy. This is about a rising PSA when the diagnosis is not made. Lots of things can cause the PSA to go up other than cancer and the Cipro is helping ferret that out.
Now…if you’ve had the prostate removed, then all the things that falsely cause the PSA to go up go away. If the PSA is up, and you have had your prostate removed , then there is only one reason for that and that is the presence of prostate cancer. I did not say the “return” of prostate cancer. Probably small amounts of undectected prostate cancer, other than in the prostate, was present at the time of the surgery. Read and understand the Partin tables. (See informative links on this site.)
So, will giving Cipro to a patient with a PSA of 5 who has had a prostatectomy for prostate cancer help? No. I am suspicious that it is not a urologist that advised this, or that the information we are given is incorrect. In any case, this patient needs a metastatic work up and a radiotherapist evaluation.
This is an example of a urologic caveat…Yes Cipro helps pre diagnosis and increased PSA-No it does not if the prostate has been treated for prostate cancer.
One Reply to “Question: Will prescribing Cipro for a rising PSA after a radical prostatectomy make a difference?”
Sounds like a good PICO question to me doc…what does the evidence show?