INFLAMMATION-LINKED PSA VARIABILITY IN BPH PATIENTS TREATED WITH ANTIBIOTICS: A LONGITUDINAL STUDY WITH HISTOPATHOLOGIC CORRELATION

Majlinda Ademi; Ilbert Ademi

doi:10.35120/medisij0501021a

Authors

Majlinda Ademi Faculty of Medical Sciences, Study Program of General Medicine, University of Tetovo, Republic of N. Macedonia Author
Ilbert Ademi General Hospital “Ferid Murad”, Department of Urology - Gostivar, Republic of N. Macedonia Author

DOI:

https://doi.org/10.35120/medisij0501021a

Keywords:

benign prostatic hyperplasia, C-reactive protein, prostate-specific antigen, prostatitis

Abstract

Benign prostatic hyperplasia (BPH) frequently coexists with prostatic inflammation, which may elevate prostate-specific antigen (PSA) and complicate differentiation from prostate cancer. To evaluate longitudinal changes in C-reactive protein (CRP) and PSA parameters following culture-guided antibiotic therapy in men with BPH, and to assess associations with prostate biopsy outcomes. A longitudinal retrospective observational study included 24 men with BPH followed from January to December 2025. CRP, total PSA (tPSA), and free PSA (fPSA) were measured at baseline without antibiotics (January) and at three subsequent timepoints (May, September, December) after antibiotic therapy guided by urine culture and antibiogram. Antibiotic regimens included levofloxacin 500 mg once daily for 28 days, nitrofurantoin 100 mg three times daily for 10 days, and cefixime 400 mg once daily for 10 days. Prostate biopsy was recommended to all patients; those declining biopsy were retained as a descriptive subgroup. Statistical analysis: Continuous variables were summarized as median and interquartile range. Repeated-measures comparisons across four timepoints were performed using the Friedman test. Between-group comparisons were performed using the Mann–Whitney U test. A two-sided p value < 0.05 was considered statistically significant. Results: CRP and PSA parameters demonstrated longitudinal variation over the four timepoints. PSA kinetics differed according to histopathologic findings among biopsied patients. Conclusion: Serial CRP and PSA assessment under culture-guided antibiotic therapy may support risk stratification and biopsy decision-making in BPH patients with suspected inflammation.

Downloads

Download data is not yet available.

References

Albisinni, P., Aoun, F., De Nunzio, C., et al. (2021). Inflammation-related PSA elevation and response to antibiotic therapy. Prostate Cancer and Prostatic Diseases, 24(3), 727–734.

American Urological Association. (2023). Early detection of prostate cancer: AUA/SUO guideline. American Urological Association.

Buddingh, K. T., Klotz, L., et al. (2017). Do antibiotics decrease PSA levels and reduce the need for prostate biopsy? A systematic review. Canadian Urological Association Journal, 11(1–2), E42–E48. DOI: https://doi.org/10.5489/cuaj.4515

Busato, W. F. S., Almeida, G. L., et al. (2015). Does PSA reduction after antibiotic therapy permit postponing prostate biopsy? International Brazilian Journal of Urology, 41, 329–336. DOI: https://doi.org/10.1590/S1677-5538.IBJU.2015.02.21

Chughtai, B., Lee, R., Te, A., & Kaplan, S. (2011). Role of inflammation in benign prostatic hyperplasia. Reviews in Urology, 13(3), 147–150.

De Marzo, A. M., Platz, E. A., Sutcliffe, S., et al. (2007). Inflammation in prostate carcinogenesis. Nature Reviews Cancer, 7(4), 256–269. DOI: https://doi.org/10.1038/nrc2090

Ferro, M., Crocetto, F., Barone, B., et al. (2024). PSA dynamics in benign prostatic enlargement and inflammatory conditions. Cancers, 16(2), 411.

European Association of Urology. (2024). EAU guidelines on prostate cancer. European Association of Urology.

Heo, J. E., et al. (2024). Clinical utility of percent free PSA in reducing unnecessary prostate biopsy. Journal of Clinical Medicine, 13(4), 1023.

Jung, K., Lein, M., Brux, B., et al. (1998). Ratio of free-to-total PSA cannot distinguish prostate cancer from chronic inflammation. The Journal of Urology, 159(5), 1595–1598. DOI: https://doi.org/10.1097/00005392-199805000-00050

Loeb, S., Carter, H. B., Berndt, S. I., et al. (2020). Prostate-specific antigen variability and clinical implications. European Urology Focus, 6(5), 932–938.

Mari, A., Campi, R., Tellini, R., et al. (2023). PSA reduction after antimicrobial therapy in suspected prostatitis. Urologic Oncology, 41(1), 12–18.

Nakai, Y., & Nonomura, N. (2013). Inflammation and prostate carcinogenesis. International Journal of Urology, 20(2), 150–160. DOI: https://doi.org/10.1111/j.1442-2042.2012.03101.x

Nickel, J. C. (2008). Inflammation and benign prostatic hyperplasia. Urologic Clinics of North America, 35(1), 109–115. DOI: https://doi.org/10.1016/j.ucl.2007.09.012

Nickel, J. C., Shoskes, D., Wang, Y., et al. (2019). Chronic prostatitis, inflammation, and PSA variability. World Journal of Urology, 37(12), 2581–2587.

Shariat, S. F., Rink, M., Karakiewicz, P. I., et al. (2022). Inflammation, PSA kinetics, and prostate cancer diagnostics. Nature Reviews Urology, 19(3), 157–172.

Stancik, I., Lüftenegger, W., Klimpfinger, M., et al. (2004). Effect of NIH category IV prostatitis on free-to-total PSA ratio. European Urology, 46(6), 760–764. DOI: https://doi.org/10.1016/j.eururo.2004.08.003

Zhou, K., et al. (2023). C-reactive protein as a prognostic biomarker in prostate cancer: A meta-analysis. Frontiers in Oncology, 13, 9935698.