From the Guidelines
For a patient with elevated PSA (5.9) and persistent yeast in urine who has an upcoming urologist appointment, I recommend treating the fungal urinary tract infection first with oral fluconazole 200mg on day 1, followed by 100mg daily for 7-14 days, as suggested by general medical principles and not directly addressed in 1 or 1. The presence of infection can artificially elevate PSA levels, so addressing this may provide clearer PSA results. Ensure adequate hydration (2-3 liters of water daily) and consider temporary avoidance of activities that might irritate the prostate, such as cycling or prolonged sitting. Avoid prostate manipulation, including ejaculation, for 48-72 hours before any repeat PSA testing. While waiting for the specialist appointment, document any urinary symptoms (frequency, urgency, hesitancy) and obtain a thorough medication history, as some medications can affect PSA levels, as noted in 1. The yeast infection should be completely cleared before reassessing PSA, as inflammation from infection can cause PSA elevation that isn't related to prostate cancer, which is a consideration in interpreting PSA results 1. This approach allows the urologist to evaluate a more accurate PSA level and determine if further investigation like prostate biopsy is necessary, taking into account the potential benefits and harms of screening as discussed in 1. It's also important to consider the patient's overall health and preferences when discussing the next steps in management, as emphasized in the guidance on shared decision-making for prostate cancer screening 1. Given the patient's age and PSA level, it's crucial to weigh the potential benefits of further evaluation against the potential harms, including the risks associated with biopsy and treatment, as outlined in 1. Ultimately, the decision to proceed with further testing or treatment should be made in consultation with the urologist, taking into account the patient's individual circumstances and preferences.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Primary Care Recommendations
To help manage a patient with elevated PSA (5.9) and ongoing yeast in urine, the following recommendations can be considered:
- The patient has an upcoming urologist appointment, which is appropriate given the elevated PSA level 2, 3, 4, 5, 6.
- The use of antibiotics, such as ciprofloxacin or levofloxacin, may be beneficial in reducing PSA levels in patients with chronic bacterial prostatitis or lower urinary tract infections 2, 3, 4, 5.
- However, a randomized, prospective, controlled multi-institutional trial found that empiric antibiotics did not have a statistically significant impact on PSA levels in men with an elevated PSA level and normal digital rectal examination 6.
- It is essential to note that approximately 50% of patients with lower urinary tract symptoms, normal digital rectal examination, and elevated PSA may experience a drop in PSA levels after antibiotic treatment, potentially avoiding unnecessary prostate biopsies 2.
- The patient's yeast in urine may be related to an underlying urinary tract infection, which could be contributing to the elevated PSA level 3, 5.
Considerations for Antibiotic Treatment
- Antibiotics, such as quinolones, macrolides, tetracyclines, and sulfa drugs, may be effective in treating chronic bacterial prostatitis 5.
- Ciprofloxacin has been shown to be effective in treating chronic bacterial prostatitis caused by Escherichia coli 5.
- The use of antibiotics should be guided by the patient's symptoms, medical history, and laboratory results, and should be prescribed judiciously to avoid unnecessary use and potential side effects 5, 6.