Well…I see patients all the time who have had an elevated PSA in the past and their family M.D. put them on 2 weeks of Cipro and then had the PSA repeated. Often times the PSA will go to normal and the family M.D. will then repeat a PSA at say 6 months. Often times it is elevated again and then the patient is sent to the urologist. This scenario happened this morning in my office. The patient wanted to do antibiotics again and then repeat the PSA again before consenting to a biopsy. A reasonable approach. We redrew the PSA. His father, a doctor, told him not to consent to a biopsy and this was the patient’s mindset before I saw him as a patient. What we will do in terms recommendations will be heavily influenced by this patient’s preconceived ideas.
My PSA was high and I did a two-week course of Cipro and my PSA went down. I was very pleased. I repeated a PSA 6 months later and the PSA was back up. I did a free PSA and the free % was low and I did the biopsy. The biopsy showed 3 areas of Gleason’s 6 and 7.
Was my elevated PSA on the basis of BPH (enlarged prostate) or cancer? I don’t know.
What did it mean that my PSA went down with an antibiotic? I don’t know.
Is it a bad idea to do a course of antibiotics and then repeat an abnormal PSA? Probably not.
If the PSA goes down after antibiotics does that mean I don’t have cancer? No.
Why do doctors give antibiotics for an elevated PSA? Thinking that a subclinical prostatitis is causing inflammation and that this is the reason for the elevated PSA.
Summary: No harm in trying antibiotics and repeating an abnormal PSA. The key is to maintain follow-up on any abnormal PSA and monitor the trend. It is important that the patient have good understanding of what you are trying to do by repeating values in the hopes of it reverting to normal and that a biopsy not be done.
The problem: Since there are so many variables about prostate cancer in terms of the rectal exam and PSA the only definitive way to know is to do a prostate biopsy. Whether this is done or not depends (usually) more on the mindset of the patient (anxious will want to biopsy-a hesitant type will drag his feet) more than the recommendation of the doctor. Trust me on this…it is more about the patient than the doctor that guides decisions in prostate cancer.