Validty of PSA Tests

[Guest guest]

I haven't seen this, but maybe I missed a posting. A piece on WebMd

(http://tinyurl.com/4vp3d) says Stamey was instrumental in

adoption of PSA tests for screening, but he has now decided it may

not be useful at all, except when testing is begun at say 40, 5

years between 40 and 50, and at one year intervals thereafter, in

order to construct a PSA trajectory.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & d

b=pubmed & dopt=Abstract & list_uids=15371827

http://tinyurl.com/6ra5s

THE PROSTATE SPECIFIC ANTIGEN ERA IN THE UNITED STATES IS OVER FOR

PROSTATE CANCER: WHAT HAPPENED IN THE LAST 20 YEARS?

Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J.

Department of Urology, School of Medicine, Stanford University,

Stanford, California.

PURPOSE:: 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. MATERIALS AND 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.

PMID: 15371827 [PubMed - as supplied by publisher]

Mike