- Email: [email protected]
Prostate specific antigen decrease and prostate cancer diagnosis: Recognizing the fundamental previous progresses and moving forward
504
LETTERS TO THE EDITOR
References
J.M. Cózar-Olmo a,∗ , B. Mi˜ nana-López b
1. Cózar JM, Hernández C, Mi˜ nana B, Amón JH, Montlleó M, Rodríguez-Antolín A, et al. Consenso sobre el impacto clínico de la nueva evidencia científica disponible sobre hiperplasia benigna prostática. Actas Urol Esp. 2012;36:265---75. 2. Cózar JM, Solsona E, Brenes F, Fernández-Pro A, León F, Molero JM, et al. Manejo asistencial del paciente con hiperplasia benigna na. Actas Urol Esp. 2011;35:580---8. de próstata en Espa˜ 3. Cózar JM, Casti˜ neiras J. Criterios de derivación de la hiperplasia benigna de próstata para atención primaria, Versión 2011. Actas Urol Esp. 2012;36:203---4.
a Vocal de Actividades Científicas de la AEU, Jefe de Servicio, Hospital Universitario Virgen de las Nieves, Granada, Spain b Coordinador del Grupo Urooncología AEU, Jefe de Servicio, Hospital Morales Meseguer, Murcia, Spain
Prostate specific antigen decrease and prostate cancer diagnosis: Recognizing the fundamental previous progresses and moving forward夽
tis was previously produced2 and subsequently confirmed by innumerous studies. Most of the references of the examined study1 are not current, and this may be corroborated by the under-recognition of important evolutions provided in the last years on the issue. The authors would be accurate if they acknowledged that this data,1 besides confirming previous results,2---5 may add no role for the association of anti-inflammatory drugs (piroxicam) in this scenario. In this setting, the main challenges are to accurately identify the patients harboring threatening cancers that will have an impact on quality and quantity of life and to improve the recognition of safe processing windows. Considering the overtreatment involved in prostate cancer management, diagnosing non-threatening cancers is controversial. There is undoubtedly room for improvement and many questions remain.
Reducción del antígeno específico de próstata y diagnóstico de cáncer de próstata: reconocer los progresos previos fundamentales y avanzar Dear Editor: We have read with interest the recently published article1 concerning the role of antibiotherapy on the prevention of supposedly unnecessary prostate biopsies in patients with high PSA values and the fact that extremely relevant and contemporary literature was ignored drew our attention. To the best of our knowledge, this scenario was rewritten in January 2010, and, since then,2---5 several (dozens) studies have confirmed that piece of data, supporting the authors’ findings.1 The best evidence nowadays comes from prospective randomized studies. In this regard, our group published for the first time in the literature 2 years ago that regardless if after antibiotics (ciprofloxacin) or placebo, half of the patients presenting high PSA (2.5---10) show PSA decrease; and regardless of the PSA changes: increase, stabilization or decrease (even at levels < 2.5 ng/dl), about one third of the patients will present positive prostate biopsy.2 It is of concern that the authors have biased their discussion and introduction sections recognizing only studies with important methodological flaws, once it is not possible to conclude that biopsies might be avoided if those with PSA decrease are not biopsied. Furthermore, the authors fail in recognizing that the knowledge supporting the fact that there is no clinical role for antibiotics in the decision for prostate biopsy among the patients without clinical prostati-
∗ Corresponding author. E-mail address: [email protected] (J.M. Cózar-Olmo).
References 1. Faydaci G, Eryildirim B, Tarhan F, Goktas C, Tosun C, Kuyumcuoglu U. Does antibiotherapy prevent unnecessary prostate biopsies in patients with high PSA values? Actas Urol Esp. 2012, http://dx.doi.org/10.1016/j.acuro.2011.07.020 [Epub ahead of print]. 2. Stopiglia RM, Ferreira U, Silva Jr MM, Matheus WE, Denardi F, Reis LO. Prostate specific antigen decrease and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial. J Urol. 2010;183:940---4. 3. Krieger JN. Editorial comment. J Urol. 2010;183:944---5 [discussion 945]. 4. Baltaci S. Editorial comment. J Urol. 2010;183:944 [discussion 945]. 5. Yoon DK, Park HS, Park JY. Re: prostate specific antigen decrease and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial: R.M. Stopiglia, U. Ferreira, M.M. Silva, W.E. Matheus, F. Denardi and L.O. Reis. J Urol. 2010;183:940---5. J Urol. 2010;184:2214---5, author reply 2215. Epub 2010 Sep 22.
L. Oliveira-Reis 夽
Please cite this article as: Oliveira-Reis L. Reducción del antígeno específico de próstata y diagnóstico de cáncer de próstata: reconocer los progresos previos fundamentales y avanzar. Actas Urol Esp.2012;36:504.
Departamento de Cirugía (Urología), Facultad de Ciencias Médicas, Universidad de Campinas, São Paulo, Brazil E-mail addresses: [email protected], [email protected]
LETTERS TO THE EDITOR
References
J.M. Cózar-Olmo a,∗ , B. Mi˜ nana-López b
1. Cózar JM, Hernández C, Mi˜ nana B, Amón JH, Montlleó M, Rodríguez-Antolín A, et al. Consenso sobre el impacto clínico de la nueva evidencia científica disponible sobre hiperplasia benigna prostática. Actas Urol Esp. 2012;36:265---75. 2. Cózar JM, Solsona E, Brenes F, Fernández-Pro A, León F, Molero JM, et al. Manejo asistencial del paciente con hiperplasia benigna na. Actas Urol Esp. 2011;35:580---8. de próstata en Espa˜ 3. Cózar JM, Casti˜ neiras J. Criterios de derivación de la hiperplasia benigna de próstata para atención primaria, Versión 2011. Actas Urol Esp. 2012;36:203---4.
a Vocal de Actividades Científicas de la AEU, Jefe de Servicio, Hospital Universitario Virgen de las Nieves, Granada, Spain b Coordinador del Grupo Urooncología AEU, Jefe de Servicio, Hospital Morales Meseguer, Murcia, Spain
Prostate specific antigen decrease and prostate cancer diagnosis: Recognizing the fundamental previous progresses and moving forward夽
tis was previously produced2 and subsequently confirmed by innumerous studies. Most of the references of the examined study1 are not current, and this may be corroborated by the under-recognition of important evolutions provided in the last years on the issue. The authors would be accurate if they acknowledged that this data,1 besides confirming previous results,2---5 may add no role for the association of anti-inflammatory drugs (piroxicam) in this scenario. In this setting, the main challenges are to accurately identify the patients harboring threatening cancers that will have an impact on quality and quantity of life and to improve the recognition of safe processing windows. Considering the overtreatment involved in prostate cancer management, diagnosing non-threatening cancers is controversial. There is undoubtedly room for improvement and many questions remain.
Reducción del antígeno específico de próstata y diagnóstico de cáncer de próstata: reconocer los progresos previos fundamentales y avanzar Dear Editor: We have read with interest the recently published article1 concerning the role of antibiotherapy on the prevention of supposedly unnecessary prostate biopsies in patients with high PSA values and the fact that extremely relevant and contemporary literature was ignored drew our attention. To the best of our knowledge, this scenario was rewritten in January 2010, and, since then,2---5 several (dozens) studies have confirmed that piece of data, supporting the authors’ findings.1 The best evidence nowadays comes from prospective randomized studies. In this regard, our group published for the first time in the literature 2 years ago that regardless if after antibiotics (ciprofloxacin) or placebo, half of the patients presenting high PSA (2.5---10) show PSA decrease; and regardless of the PSA changes: increase, stabilization or decrease (even at levels < 2.5 ng/dl), about one third of the patients will present positive prostate biopsy.2 It is of concern that the authors have biased their discussion and introduction sections recognizing only studies with important methodological flaws, once it is not possible to conclude that biopsies might be avoided if those with PSA decrease are not biopsied. Furthermore, the authors fail in recognizing that the knowledge supporting the fact that there is no clinical role for antibiotics in the decision for prostate biopsy among the patients without clinical prostati-
∗ Corresponding author. E-mail address: [email protected] (J.M. Cózar-Olmo).
References 1. Faydaci G, Eryildirim B, Tarhan F, Goktas C, Tosun C, Kuyumcuoglu U. Does antibiotherapy prevent unnecessary prostate biopsies in patients with high PSA values? Actas Urol Esp. 2012, http://dx.doi.org/10.1016/j.acuro.2011.07.020 [Epub ahead of print]. 2. Stopiglia RM, Ferreira U, Silva Jr MM, Matheus WE, Denardi F, Reis LO. Prostate specific antigen decrease and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial. J Urol. 2010;183:940---4. 3. Krieger JN. Editorial comment. J Urol. 2010;183:944---5 [discussion 945]. 4. Baltaci S. Editorial comment. J Urol. 2010;183:944 [discussion 945]. 5. Yoon DK, Park HS, Park JY. Re: prostate specific antigen decrease and prostate cancer diagnosis: antibiotic versus placebo prospective randomized clinical trial: R.M. Stopiglia, U. Ferreira, M.M. Silva, W.E. Matheus, F. Denardi and L.O. Reis. J Urol. 2010;183:940---5. J Urol. 2010;184:2214---5, author reply 2215. Epub 2010 Sep 22.
L. Oliveira-Reis 夽
Please cite this article as: Oliveira-Reis L. Reducción del antígeno específico de próstata y diagnóstico de cáncer de próstata: reconocer los progresos previos fundamentales y avanzar. Actas Urol Esp.2012;36:504.
Departamento de Cirugía (Urología), Facultad de Ciencias Médicas, Universidad de Campinas, São Paulo, Brazil E-mail addresses: [email protected], [email protected]