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

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.