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Dr. Patrick Walsh, MD
T he use of ciprofloxacin (Cipro) as a test to see whether an elevated PSA level will decrease is controversial.

On one hand, clinical experience has shown that if the PSA decreases to previously low levels, it is possible to avoid a prostate biopsy procedure altogether.

On the other hand, infectious disease experts are concerned that widespread use of Cipro in this fashion might lead to the emergence of intestinal bacteria that are resistant to multiple antibiotics and could cause life-threatening infections.

In addition, use of Cipro has been linked to side effects resulting in damage, and sometimes even ruptures, to tendons.

It is possible that antibiotics other than Cipro may be less likely to produce resistant bacteria, but this has not been proven.

My current practice is to prescribe an antibiotic other than Cipro to see if the PSA decreases. If it doesn’t, I wait one month to give the intestinal bacteria a chance to return to normal and then perform a biopsy.

Alternatively, some patients elect to see whether the PSA will decrease spontaneously without antibiotics and avoid the risk of developing resistant bacteria in their intestines.

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