Facts on File Encyclopedia of Health and Medicine

Risks and Complications
Prostatectomy, particularly an open or radical
approach, is extensive surgery with potential com-
plications that require careful consideration.
Among them are excessive bleeding during or
after surgery that may necessitate BLOOD TRANSFU-
SION, INFECTION, retrograde ejaculation, urinary
incontinence, bladder damage, rectal damage, and
erectile dysfunction. Generalized risks include
reaction to ANESTHESIAand blood clots. The risk for
complications depends on the reason for the
prostatectomy (cancer or noncancerous condi-
tion), the type of operation, age, and overall
health status. Surgeons prescribe prophylactic
antibiotics to help prevent infection and antiem-
bolism therapies such as ANTICOAGULATION THERAPY
and compression stockings or boots to help pre-
vent blood clots.

Outlook and Lifestyle Modifications

For many men, prostatectomy ends the symptoms
of the condition that necessitated the operation.
Because the prostate gland continues to slowly
enlarge as a man ages, about 20 percent of men
who have TURP to treat BPH find their symptoms
return in 10 to 15 years, requiring additional
treatment. Many men are able to return to normal
activities, including sexual activities, within a few
months of their surgeries. However, prostate can-
cer may require adjuvant (follow-up or accompa-
nying) treatment after surgery.
See also ANTIBIOTIC PROPHYLAXIS; CANCER TREAT-
MENT OPTIONS AND DECISIONS; SURGERY BENEFIT AND
RISK ASSESSMENT.

prostate-specific antigen (PSA) An enzyme
PROSTATE GLANDcells produce. Prostatic fluid, the
cumulative secretions of prostate gland cells, con-
tains high levels of PSA. PSA acts on the jellylike
substance that encases SPERMduring their storage
in the seminal vesicles, liquefying the substance
when the sperm mix with prostatic fluid in the
URETHRA during EJACULATION. This action restores
motility to the sperm.
Measuring the BLOODconcentration of PSA pro-
vides information about the health status of the
prostate gland. In the healthy prostate gland of a
man under age 40, the prostate gland cells form a
tight structure that directs nearly all PSA the cells

produce into the prostatic fluid; only a small

amount of PSA escapes to circulate in the blood.

In certain health conditions, most notably PROSTATE

CANCER, PSA blood levels rise. Prostate cancer dis-

rupts the structure and organization of prostate

gland cells, allowing much higher concentrations

of PSA to enter the blood circulation. Other health

conditions such as PROSTATITIS, BENIGN PROSTATIC

HYPERPLASIA(BPH), and even URINARY TRACT INFEC-

TION(UTI) can also cause PSA levels to rise.

As well, PSA also normally rises with increasing

age because the prostate gland slowly enlarges

beginning around age 40, a process that also alters

the structure and organization of prostate gland

cells. Because of this natural change, normal PSA

blood values differ according to a man’s age. Blood

PSA concentrations above the value for age may

suggest the presence of prostate disease, including

prostate cancer. In general, a blood PSA level of 4

nanograms per milliliter (ng/mL) may indicate the

need for further evaluation of the prostate gland’s

health.

NORMAL VALUES FOR

BLOOD PROSTATE-SPECIFIC ANTIGEN (PSA) LEVELS

Age PSA Blood Concentration

40 to 49 < 2.5 nanograms per milliliter (ng/mL)

50 to 59 < 3.5 ng/mL

60 to 69 < 4.5 ng/mL

70 to 79 < 6.5 ng/mL

However, health experts disagree about the

value of blood PSA levels for prostate cancer

screening and detection. There is limited consen-

sus around what the values mean, there are sev-

eral methods for measuring PSA that are not

equivalent to one another, and there is a higher

rate of false-positive PSA results—PSA levels that

are elevated for reasons other than prostate dis-

ease—than many doctors find acceptable. These

factors are of concern because the next step of

diagnosis, biopsy, is invasive and carries risk for

numerous complications. Many doctors find PSA

blood tests more useful when treating disorders of

the prostate gland, such as BPH and prostate can-

cer, as measures to help assess the effectiveness of

treatment.

See also AGING, REPRODUCTIVE AND SEXUAL

CHANGES THAT OCCUR WITH; CANCER PREVENTION.

prostate-specific antigen (PSA) 333