Encyclopedia of Health and Medicine

prostate-specific antigen (PSA) 333
Risks and Complications
Prostatectomy, particularly an open or radical
approach, is extensive surgery with potential complications
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 ANESTHESIA and blood clots. The risk for
complications depends on the reason for the
prostatectomy (cancer or noncancerous condition),
the type of operation, age, and overall
health status. Surgeons prescribe prophylactic
antibiotics to help prevent infection and antiembolism
therapies such as ANTICOAGULATION THERAPY
and compression stockings or boots to help prevent
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 cancer
may require adjuvant (follow-up or accompanying)
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 GLAND cells produce. Prostatic fluid, the
cumulative secretions of prostate gland cells, contains
high levels of PSA. PSA acts on the jellylike
substance that encases SPERM during 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 BLOOD concentration of PSA provides
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 disrupts
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 consensus
around what the values mean, there are several
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 disease—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 cancer,
as measures to help assess the effectiveness of
treatment.
See also AGING, REPRODUCTIVE AND SEXUAL
CHANGES THAT OCCUR WITH; CANCER PREVENTION.