A COMBINED THERAPY WITH NIMESULIDE, SERENOA REPENS AND BROMELINE IS EFFECTIVE ON REDUCING ABNORMAL PSA LEVELS IN ORDER TO AVOID UNNECESSARY PROSTATE BIOPSIES
INTRODUCTION AND OBJECTIVES:
65-70% of patients with abnormal prostate specific antigen (PSA) do not have cancer on prostate needle biopsy. Prostate biopsy is a costly and a potentially morbid procedure. Prostatitis is commonly reported on needle biopsies. To reduce the number of unnecessary prostate biopsies we evaluated the effect of a combined therapy with nimesulide, serenoa repens and bromeline in lowering PSA levels.
MATERIAL AND METHODS:
All patients coming to our Institute with PSA levels between 4 and 10 ng/ml were included in this study. Exclusion criteria were: 1)abnormal digital rectal examination ; 2) suspicious prostate imaging (TRUS or MRI) 3) diagnosis of a bacterial form of prostatitis assessed after lower urinary tract localisation studies. Recruited subjects received a combination therapy with oral nimesulide 100 mg bidaily for one week, oral bromeline 200 mg bidaily for 10 days and Serenoa repens 320 mg for one month. PSA levels were dosed again after the treatment. Prostate biopsy was omitted in case of PSA reduction lower than 4 ng/ml.
42 patients entered the study. All patients completed treatment without major adverse reactions. Mean PSA levels at baseline was 6,6 ± 1,6 SD. After completion of treatment we assisted to PSA reduction less than 4 ng/ml in 23/43 patients (53,5%) who were spared to undergo prostate biopsy. Mean PSA levels after our therapeutic protocol was 4,4 ± 1,9 SD. Among remaining 20 patients who underwent biopsies 9 (45% ) received the diagnosis of prostate cancer and 8 (40%) of prostatitis.
A combination therapy with nimesulide, bromeline and serenoa repens was effective to avoid prostate biopsy in the 53,5% of our survey. Furthermore this therapeutic regimen seems to be effective to select the right patients to undergo prostate biopsy increasing the accuracy of this diagnostic procedure.