***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose We aim ed to reduce unnecessary prostatic biopsy in patients with high prostate-specific antigen ( PSA ) by consideration of prostatic inflammation . Material s and Methods The investigation was conducted prospect ively in 413 patients with a PSA level of 4 to 10 ng/ml from January 2004 to December 2009 . All patients underwent the expressed prostatic secretion ( EPS ) or voided bladder urine 3 ( VB3 ) test to be classified into two groups : positive group and negative group . Patients with a positive result on the EPS or VB3 test were treated with antibiotics for 2 months , and in cases in which the PSA level remained high , we performed prostate biopsy . In patients with a negative result on the VB3 test , we performed prostate biopsy directly . Results Of the 413 study patients , 215 ( 52 % ) patients had positive findings on the EPS or VB3 test . After 8 weeks of antibiotics therapy , 53 of the 215 men avoided prostate biopsy because their PSA level was normalized . The other patients ( 162 of 215 ) still had elevated PSA levels of more than 4 ng/ml , including 7 patients in whom the biopsy revealed cancer . Patients with negative findings ( 198 of 413 ) underwent prostate biopsy . Of the 198 patients , 41 were diagnosed with prostate cancer . The total prostate cancer detection rate was 11.6 % in our subjects , where as it was 20.7 % in the patients with negative findings on the EPS or VB3 and 3.3 % in the patients with positive findings , respectively . Conclusions In cases in which the PSA level is increasing , if we first exclude prostatitis and carry out a serial diagnostic procedure , it may help to reduce unnecessary prostatic biopsy Purpose We investigated the effect of antibiotics on PSA in asymptomatic patients with mild PSA elevation . Material s and Methods We prospect ively evaluated , in a non-r and omized design , 106 asymptomatic patients with PSA of 4 - 10ng/mL , with a negative digital rectal examination and with no urinary tract infection evidence for 2 years . Patients were divided into two groups : those treated with antibiotics for 3 weeks ( G1 ) and those who were not treated ( G2 ) .  PSA  was taken six weeks after and prostate biopsy was performed in all patients . Results PCa was diagnosed in 25 of 106 patients ( 23.6 % ) : 16 ( 25.0 % ) in G1 and 9 ( 21.4 % ) in G2 ( p>0.05 ) . PSA normalization was experienced in 24.5 % . In G1 , PSA returned to < 4ng/mL in 15 ( 23.4 % ) patients compared to 11 ( 26 % ) patients in G2 . In the patients with a positive biopsy , no significant variation was noted in PSA , fPSA , % fPSA and DPSA after antibiotic treatment . A significantly lower cancer detection rate was noted with decreased PSA , fPSA , and DPSA after antibiotic use . A PSA reduction rate of ≥10 % occurred in 58.5 % , and this was similar in both G1 and G2 groups . The sensibility , specificity and accuracy of PSA reduction of ≥10 % were 31 % , 23 % and 25 % , respectively . Conclusion Empirical antibiotic therapy in asymptomatic male patients is not related to PSA reduction . The greater than 10 % PSA reduction after antibiotic in this population can not postpone prostate biopsy PURPOSE This controlled prospect i ve study aims to investigate the possible effects of antibiotic treatment on prostate-specific antigen ( PSA ) and its derivatives , and consequently on the transrectal biopsy rates , in the diagnosis of prostate cancer . PATIENTS AND METHODS One hundred and forty patients aged 45 to 70 years old , with a PSA level between 2.5 and 10 ng/mL and normal digital rectal examinations ( DRE ) , were included in this study between June 2009 and November 2010 . The patients were r and omly assigned into two groups . The first group received oral levofloxacin 500 mg 1 * 1 for 21 days ; the second , the control group , was given no treatment . Initially , total PSA , free PSA , a DRE , urinary ultrasonography ( including prostate volume , postvoiding residual urine ) , uroflowmetry , International Prostate Symptom Score , National Institutes of Health Chronic Prostatitis Symptom Index , and International Index of Erectile Function tests were performed . All of these were repeated at the end of 3 weeks of antibiotic treatment . An additional PSA measurement was also performed at day 10 of the treatment . All patients underwent transrectal ultrasonography ( TRUS ) guided prostate biopsy at day 21 , just the day after the final ( third ) PSA sampling . RESULTS The mean age of the patients was 59.6 years . Overall , in 23 patients ,  prostate cancer was detected , including those found in the rebiopsies . Statistically , there were significant changes in values of PSA and its derivatives in the treatment group ( from 5.31 to 4.69 and 4.58 ng/mL , consecutively ) . Focusing on prostate cancer patients in both the treatment and control groups , however , we did not detect any significant change in the same parameters . CONCLUSION Antibiotic treatment given to the patients with a PSA level between 2.5 and 10 ng/mL can be beneficial , before a decision for TRUS guided prostate biopsy , just in a limited subgroup , by reducing the PSA levels below the threshold value . Considering the large population of patients in the gray zone , however , it still does not provide clear solid evidence for avoiding unnecessary prostate biopsies INTRODUCTION We investigated if antibiotherapy has any role on total PSA ( tPSA ) , free PSA ( fPSA ) and fPSA/tPSA ratio in patients with tPSA higher than 2.5ng/ml . We also analyzed if it has any relation with prostate cancer diagnosis rate . MATERIAL AND METHODS A total 108 patients older than 50 years of age with lower urinary system sypmtoms and tPSA > 2.5ng/ml were included in this study .  Antibiotherapy was given to all the cases for three weeks . After that , transrectal ultrasound-guided prostate biopsies were taken from all the patients . Before and after antibiotherapy , " The International Prostate Symptom Score " ( IPSS ) and " National Institutes of Health Chronic Prostatitis Symptom Index " ( NIH-CPSI ) questinories are performed and serum tPSA , fPSA and fPSA/tPSA values were obtained . RESULTS TPSA , fPSA and fPSA/tPSA ratio alterations prior to and after antibiotherapy did not show any statistically significant difference ( p>0.05 ) . When prostate adenocarcinoma was excluded , an statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases . CONCLUSIONS Antibiotherapy given to patients with PSA levels higher than threshold value has not led to significant change in prostate needle biopsy decision . Prostate biopsy should be considered without trying antibiotherapy in patients with high PSA values if a suspicion of prostatitis does not exist PURPOSE We compared baseline and post-therapy prostate specific antigen ( PSA ) in patients with chronic bacterial prostatitis who were treated with levofloxacin or ciprofloxacin .  MATERIAL S AND METHODS Subset analysis was done using a r and omized , multicenter , double-blind , active control trial of 500 mg levofloxacin daily for 28 days vs 500 mg ciprofloxacin twice daily in 28 days in men with chronic bacterial prostatitis . RESULTS Of the 377 men in the intent to treat population , including 197 treated with levofloxacin and 180 treated with ciprofloxacin , 35 on levofloxacin and 37 on ciprofloxacin with baseline PSA greater than 4 ng/ml were included in this analysis . Excluded from analysis were 2 levofloxacin treated patients with extremely high PSA at baseline ( 62 and 103 ng/ml , respectively ) . Mean baseline PSA + /- SD in the patients analyzed was 8.33 + /- 4.46 ng/ml , which decreased to 5.36 + /- 3.82 ng/ml after therapy . There was no significant difference in the mean change in PSA between the levofloxacin and ciprofloxacin groups . Approximately 42 % of patients with increased baseline PSA had a post-therapy PSA of 4 ng/ml or less . Of patients who were microbiologically evaluable and had normalized PSA after therapy levofloxacin  eradicated the pathogen in 90.9 % ( 10 of 11 ) . However , of patients in whom post-therapy PSA remained increased the microbiological eradication rate was 69.2 % ( 9 of 13 ) . Similarly 93.3 % of the ciprofloxacin group ( 14 of 15 patients ) with normalized post-therapy PSA experienced microbiological eradication compared with 61.5 % ( 8 of 13 ) with continued increased PSA after therapy . CONCLUSIONS Approximately 20 % of patients diagnosed with chronic bacterial prostatitis had increased PSA . A significant decrease in PSA was observed in these patients after treatment with levofloxacin or ciprofloxacin . An association was observed between bacterial persistence and the likelihood that PSA would return to normal PURPOSE We attempted to identify morphological parameters of benign prostatic hyperplastic inflammation that correlate with pre-biopsy prostate specific antigen ( PSA ) concentrations . MATERIAL S AND METHODS Patients undergoing prostate biopsy at our department were prospect ively studied between January 1995 and January 1996 .  preoperative blood and 24-hour urine sample s were measured for PSA . Biopsy sample s harboring exclusively benign prostatic tissue were grade d on a 4-point scale for inflammation ( 0-no inflammatory cells , 1-scattered inflammatory cell infiltrate , 2-nonconfluent lymphoid nodules and 3-large inflammatory areas with confluence of infiltrate ) and aggressiveness ( 0-no contact between inflammatory cells and gl and ular epithelium ; 1-contact between inflammatory cell infiltrate and gl and ular epithelium ; 2-clear but limited , that is less than 25 % of the examined material , gl and ular epithelium disruption , and 3-gl and ular epithelium disruption on more than 25 % of the examined material ) . RESULTS A total of 66 patients with exclusively benign prostatic tissue on prostate biopsies was analyzed . Difference between inflammation grade d groups was not significant when considering serum or urinary PSA . There was a significant correlation between aggressiveness grading and serum PSA ( rho = 0.51 , p < 0.0001 ) , whereas aggressiveness grading and urinary PSA did not correlate ( rho = -0.06 , p = 0.6 ) . CONCLUSIONS Prostatic sub clinical inflammation is not associated with high urinary PSA . Unless associated with gl and ular epithelial disruption , density of prostatic interstitial inflammatory cell infiltrate is not significantly correlated with serum PSA concentration . We believe that this issue should be considered when interpreting a prostate biopsy Purpose We evaluated men with documented chronic prostatitis and elevated serum prostate-specific antigen ( PSA ) to determine whether treatment with antibiotics and anti-inflammatory drugs can lower serum PSA and the cancer detection rate in patients with post-treatment PSA < 4 ng/ml . Material s and Methods Eighty-six men who presented with serum PSA greater than 4 ng/ml and who were subsequently diagnosed with chronic prostatitis with greater than 10 white blood cells per high power field in expressed prostatic excretions were included in this prospect i ve study . Patients meeting these criteria underwent treatment with a 4-week course of antibiotics and nonsteroidal anti-inflammatory agents .  Follow-up PSA and transrectal ultrasonography-guided prostate biopsy  were performed within 2 months of treatment for all patients . Results Mean patient age was 56.2 years ( range , 37 - 72 years ) .  Mean PSA ( ng/ml ) decreased by 33.8 % , from 8.12 ( range , 4.02 - 24.8 ) to 5.37 ( range , 1.35 - 12.94 ) , after treatment ( p=0.001 ) . Pathological studies revealed prostate cancer in 18 cases ( 20.9 % ) , chronic inflammation in 64 ( 74.4 % ) , and benign prostatic hypertrophy in 4 ( 4.7 % ) . The prostate cancer detection rate according to the follow-up PSA level , below 2.5 , from 2.5 to 4.0 , and above 4.0 , was 13.3 % ( 2/15 ) , 13.6 % ( 3/22 ) , and 26.5 % ( 13/49 ) , respectively . Conclusions When chronic prostatitis with elevated PSA is identified , antibiotic and anti-inflammatory treatment can lower these PSA levels . However , the possibility of prostate 
    Output:
    
No cancer was detected if the PSA level decreased to < 4 ng/mL. Conclusion : Antibiotic therapy is clinical ly beneficial in patients with high PSA levels .
PSA reduction or normalisation after medical therapy , either antibiotic and /or NSAID , for ≥ 2 weeks can avoid unnecessary PBx .