Prostate Cancer Test Declared Useless By PSA Pioneer

Health Talk ^ | 09.11.06

[Coleus]

The PSA test, used to screen men for detecting prostate cancer has been declared all but useless by a pioneer in the procedure. Stanford University School of Medicine professor Dr. Thomas Stamey said "The PSA era is over in the United States." Dr. Stamey and colleagues examined more than 1,300 prostate tissue samples removed by urologists at Stanford over the past 20 years. Researchers divided the data from the samples into four five-year periods between 1983 and 2004. They found a substantial decrease in the connection between PSA levels and the amount of prostate cancer over time. In the first five-year group, 43 percent had a prostate cancer relationship to PSA testing, that relationship dropped to only 2 percent in the most recent group.

"Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more," said Dr. Stamey, referring to his study published in the October issue of the Journal of Urology.

In 1987, Dr. Stamey, the pioneer in PSA testing published his original findings in the New England Journal of Medicine showing that increased blood PSA levels could be used to indicate prostate cancer. However, now, Dr. Stamey believes the PSA test is not a useful predictor of prostate cancer, but only reflects a harmless increase in prostate size.

Dr. Stamey also believes it's time to stop removing every man's prostate who has prostate cancer. "We originally thought we were doing the right thing, but we are now figuring out how we went wrong. Some men need prostate treatment but certainly not all of them."

All men will get prostate cancer if they live long enough, said Dr. Stamey, and if there is an excuse such an elevated PSA test, a biopsy will be performed, and cancer will be found. But the cancer found will likely be insignificant.

Dr. stamey recommends a yearly digital rectal exam for all men over 50, as opposed to PSA testing to detect prostate cancer. "If a cancer is felt in the prostate during a rectal examination, it is always a significant cancer and certainly needs treatment," Dr. Stamey said.

[arthurus]

Don't we want to take care of these things before they become "significant?"

[oyez]

Oh no! Here comes the finger, again.

[oxcart]

PSA TEST BTTT (((PING)))

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 94305, USA. tstamey@stanford.edu

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 - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15371827&query_hl=8&itool=pubmed_docsum