Choosing Wisely:

Don’t treat an elevated prostate-specific antigen (PSA) with antibiotics for patients not experiencing other symptoms.

Rationale and Comments: It had previously been suggested that a course of antibiotics might lead to a decrease in an initially raised PSA and reduce the need for prostate biopsy; however, there is a lack of clinical studies to show that antibiotics actually decrease PSA levels. It should also be noted that a decrease in PSA does not indicate an absence of prostate cancer. There is no information available on the implications of deferring a biopsy following a decrease in PSA.
Sponsoring Organizations:
  • American Urological Association
  • Sources:
  • Randomized controlled trials
  • Disciplines:
  • Urologic
  • References: • Heldwein FL, et al. Antibiotics and observation have a similar impact on asymptomatic patients with a raised PSA. BJU Int. 2011;107(10):1576-81.
    • Stopliglia RM, et al. Prostate specific antigen and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial. J Urol.2010;183(3):940-4.

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