Stamey PSA is Over

20 year study
1,317 consecutive radical prostatectomies between August 1983 and July 2003
Palpable nodules on digital rectal exam decreased from 91% per 17%
Mean age decreased from 64 to 59
PSA decreased from 25 to 8
Cancer index volume decreased from 5.3 to 2.4 ccs
By the end of the study serum PSA correlated only to prostate size, not to prostate cancer size, or Gleason grades.
The study concludes that serum PSA is now misleading in the diagnosis of prostate cancer, and that PSA is better for diagnosing prostate enlargement.
In the past relapse of prostate cancer was associated with cancer size and percent of Gleason grade 4/5 present.
The authors say, “There is now no clinical relationship between serum PSA and the largest cancer in the prostate.” There is now, “… no correlation of serum PSA with any morphological variable except prostate weight.”
The authors say that prostate cancer “… has an extraordinarily small death rate of 226 per 100,000 men older than 65 years.” (0.226 percent.)
The authors reiterate “… the relationship of serum PSA in the last 5 years rests exclusively with benign enlargement of the prostate.”
The authors say that lowering the threshold of PSA for recommending a biopsy is unwarranted.
The authors ask, “In the meantime what are we to do in the face of such massive, unwarranted PSA screening?”
The authors finally conclude, “…any excuse to biopsy the prostate has an excellent, age dependent chance of being positive.

The Stamey paper is excellent science. The one major flaw in the study is that the men were not tested for prostatitis, and thus they cannot conclude the PSA is related to BPH, when in fact, it may be more related to prostatitis.

Reference on Prostate Cancer

Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J: The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? Journal of Urology. 2004 Oct;172(4 Pt 1):1297-301.

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© 2004 Bradley Hennenfent, MD