The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?
OBJECTIVE
We assessed how well preoperative serum prostate specific antigen (PSA) reflects the largest cancer in consecutive untreated radical prostatectomies during the last 20 years at Stanford University.


METHODS
A total of 1,317 consecutive radical prostatectomies were divided into 4, 5-year periods between August 1983 and July 2003, and examined sequentially in 3 mm step sections by 1 pathologist. The largest cancer and 5 other histological variables in each prostate were measured. Preoperative clinical stages were tabulated for each 5-year period. Means, Pearson correlation coefficients, % change and multiple regression were used to compare selected variables.


RESULTS
Most parameters decreased linearly during the 20 years, including palpable nodules on digital rectal examination from 91% to 17%, mean age from 64 to 59 years, mean serum PSA from 25 to 8 ng/ml, and index (largest) cancer volume from 5.3 to 2.4 cc. Percent Gleason grade 4/5 of the largest cancer averaged 27% to 35% and prostate weight 44 to 53 gm. Contrasting August 1983 to December 1988 with January 1999 to July 2003, 6 histological cancer parameters had statistically significant relationships to serum PSA in the first period. In the last 5 years serum PSA was related only to prostate size.


CONCLUSIONS
Serum PSA was related to prostate cancer 20 years ago. In the last 5 years serum PSA has only been related to benign prostatic hyperplasia. There is an urgent need for serum markers that reflect the size and grade of this ubiquitous cancer.
Stamey
Thomas A
TA
Department of Urology, School of Medicine, Stanford University, Stanford, California 94305, USA. tstamey@stanford.edu
Caldwell
Mitchell
M
McNeal
John E
JE
Nolley
Rosalie
R
Hemenez
Marci
M
Downs
Joshua
J
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002140:California; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012044:Regression Analysis; D012189:Retrospective Studies; D013223:Statistics as Topic; D017211:Treatment Failure
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen