Q: Recently, a 47-year-old asymptomatic patient had a random prostate-specific antigen (PSA) level of 5.32 ng/mL. A repeat assay the following day was 6.10. All previous PSAs over a seven-year period had been in the 0.4-0.9 range; the most recent determination (July 2005) was 0.8. After two weeks of levofloxacin (Levaquin), the PSA had dropped but was still too high at 4.76. An ultrasound-guided biopsy at 12 needle sites was negative, and the patient was advised to return for rechecks twice annually for the next 12-18 months. Now, after reading that one to two months of antibiotics may be needed to treat prostatitis (“To the Editor —PSA testing through the ages,” September 2006), I wonder if two more weeks of levofloxacin might have averted the biopsy. Your comments, please.
—Jeffrey W. Glassheim, DO, Oshkosh, Wis.

A: The key point here is diagnosing the prostatitis, which can be done symptomatically on the basis of complaints of urgency, frequency, dysuria, or perineal pain. However, Dr. Glassheim’s patient was felt to be asymptomatic. To diagnose prostatitis in this case, one needs to obtain a post-prostatic massage fluid specimen and document >20 WBCs per high-power field. In the absence of prostatitis, an elevated PSA would be unlikely to change because of antibiotic therapy, regardless of the duration of therapy.
—David T. Noyes, MD (98-11)

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