If an elevated PSA goes down after antibiotics does that mean you don’t have prostate cancer?


my friends my habits my family...they mean so much to me.... modest mouse

 

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.

5 Replies to “If an elevated PSA goes down after antibiotics does that mean you don’t have prostate cancer?”

  1. John yet another important piece of the jigsaw for me and my understanding of why and when to do a biopsy, as you say a biopsy is about the informed patient.
    Its so refreshing to read about a Urologist that practices shared decision making for those men who want to be part of the process.

    Keith
    red sock campaign

    Like

  2. Hi Dr. McHugh, I have an elevated PSA and Low testosterone. I have supplemented test. for over 20 years. I used test. cyp., patch, gel, and HCG. All will great success. About a year ago PSA elevated. DRE suggested enlarged prostate. Dc’ed test. and started Cipro 750mg 3wks, no effect. Prostatitis symptoms present but not remarkable, mostly transient.
    Obviously, I been told I need biopsy. I really don’t want one! Show me someone that does and I show you a good psych referral. I’m not really opposed to the pain of it. I fear it will be negative. Then what; more biopsys?
    I have researched the topic and found research on MRI/MRSI. I’m attaching link to one review I found interesting. http://www.seas.upenn.edu/~ouya/documents/others/Ahmed09.pdf

    So, the questions I have are:
    1. I read that 25-30 percent of prostate biopsys are positive for CA. Of the positives, what percent are agressive enough to require treatment.?

    2. In the presence of the opportunity to exploit this type of imaging prebiopsy, wouldn’t the small probability of a CA requiring treatment, merit the less invasive approach?

    3. Assuming a finding positive for CA, agressive or nonaggressive, is there precedent for continued test. supplementation? When not supplementing, I’ve experienced the physiological and psychological symptoms associated with low testosterone. I’d rather have a biopsy! Low test. is just not an option.

    4. I have an appointment with you next week. Do you really want to work with a patient so opposed to biopsy? 🙂

    Like

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