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

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Abstract
Objective: To determine the frequency of prostatic involvement in men with community‐acquired febrile urinary tract infection.Patients and methods: This prospective study included 70 men (18–85 years old) who had a fever of ≥38.0 °C, symptoms or signs of urinary tract infection and a positive urine culture. Serum prostate‐specific antigen (PSA) was measured and transrectal ultrasonography of the prostate and seminal vesicles performed during the acute phase of the disease 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 levels, patient age, inflammatory response to infection or presence of positive blood cultures. Despite a rapid decline in PSA level after one month, there was a protracted decrease in some patients. After 3 months the median prostate volume was reduced by 31% (range 11–54; Pr=0.36, 95% confidence interval 0.09–0.58; P=0.01).Conclusion: These results show that the prostate and seminal vesicles are frequently involved in men with febrile urinary tract infection and that PSA may be a useful marker of prostatic infection. The slow decline of PSA levels in some patients after appropriate antibiotic treatment indicates a protracted healing process and should be considered when PSA is used to detect prostate cancer.