title: The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?
abstract: 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.
authors.affiliation: Department of Urology, School of Medicine, Stanford University, Stanford, California 94305, USA. tstamey@stanford.edu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Stamey
authors.forename: Mitchell
authors.initials: M
authors.lastname: Caldwell
authors.forename: John E
authors.initials: JE
authors.lastname: McNeal
authors.forename: Rosalie
authors.initials: R
authors.lastname: Nolley
authors.forename: Marci
authors.initials: M
authors.lastname: Hemenez
authors.forename: Joshua
authors.initials: J
authors.lastname: Downs
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen