Prostatic involvement in men with febrile urinary tract infection as measured by serum prostate-specific antigen and transrectal ultrasonography

Objective To determine the frequency of prostatic involvement in men with c ommunity-acquired febrile urinary tract infection. Patients and methods This prospective study included 70 men (18-85 years ol d who had a fever of greater than or equal to 38.0 degrees C, symptoms or s igns of urinary tract infection and a positive urine culture, Serum prostat e-specific antigen IPSA) was measured and transrectal ultrasonography of th e prostate and seminal vesicles performed during the acute phase of the dis ease and during a 1-year follow-up. Results Although only six patients had a tender prostate on digital rectal examination. the initial serum PSA level was elevated in 58 (83%) patients (median 14 ng/mL. range 0.54-140). There was no correlation between PSA lev els, patient age, inflammatory response to infection or presence of positiv e blood cultures, Despite a rapid decline in PSA level after one month. the re was a protracted decrease in some patients. After 3 months the median pr ostate volume was reduced by 31% (range 11-54: P < 0.001) in 46 of 55 patie nts examined, and the width of the right and left seminal vesicle was reduc ed by 14% and 22%, respectively. The reductions in PSA and prostate volume were significantly correlated (r = 0.36, 95% confidence interval 0.09-0.58; P = 0.01). Conclusion These results show that the prostate and seminal vesicles are fr equently involved in men with febrile urinary tract infection and that PSA map be a useful marker of prostatic infection. The slow decline of PSA leve ls in some patients after appropriate antibiotic treatment indicates a prot racted healing process and should be considered when PSA is used to detect prostate cancer.