# Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate

Source: https://onco.cc/key-papers/paper-stamey-psa-serum-marker-nejm-1987/  
OnCo record `paper-stamey-psa-serum-marker-nejm-1987` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The paper that turned a protein made by the prostate into the blood test now used on millions of men a year. It showed the level tracked how much cancer there was, fell to nothing after surgery, and rose again when the cancer came back.

## Summary

Thomas Stamey and colleagues at Stanford measured prostate-specific antigen and prostatic acid phosphatase by radioimmunoassay in 2,200 serum samples from 699 patients, 378 of whom had prostate cancer, and compared the two markers directly.

Prostate-specific antigen won on every axis that mattered for monitoring: it was more sensitive, it tracked tumour volume, it fell to undetectable after radical prostatectomy with a half-life of 2.2 days, and it detected recurrence. The paper's own conclusion is careful in a way the following twenty years were not: because both markers are also raised in benign prostatic hyperplasia, neither is specific. Stamey later became one of the loudest critics of the screening programme his paper enabled.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Also known as: Stamey 1987; PSA serum marker 1987
- Tags: prostate-evidence
- Journal: New England Journal of Medicine
- Year: 1987
- DOI: 10.1056/nejm198710083171501
- Authors: Stamey TA, Yang N, Hay AR, et al.
- Findings: Prostate-specific antigen was elevated in 122 of 127 patients with newly diagnosed, untreated prostatic cancer, including 7 of 12 with unsuspected early disease and all 115 with more advanced disease.; The level increased with advancing clinical stage and was proportional to the estimated volume of the tumour; prostatic acid phosphatase was elevated in only 57 of the cancer patients and correlated less closely with volume.; Prostate-specific antigen was increased in 86 percent and prostatic acid phosphatase in 14 percent of patients with benign prostatic hyperplasia.; After radical prostatectomy the antigen routinely fell to undetectable levels, with a half-life of 2.2 days.; The authors concluded that because both markers may be elevated in benign prostatic hyperplasia, neither is specific.
- What it means: The origin of the blood test that defines how prostate cancer is found, monitored and declared to have recurred. Its strength was always monitoring a known cancer; the problems began when the same test was used to look for cancer in men who had no symptoms.
- Caveats: A marker validation study in a hospital population, not a screening study; the screening question was not asked here.; The paper states plainly that the marker is not specific, a caveat that the subsequent adoption of population testing largely ignored.; Radioimmunoassay values from 1987 are not directly comparable with modern assays, and there is no single international standard threshold.

## Sources

- N Engl J Med 1987: https://doi.org/10.1056/nejm198710083171501
- PubMed: https://pubmed.ncbi.nlm.nih.gov/2442609/

## Connected records

- key papers: [Measurement of prostate-specific antigen in serum as a screening test for prostate cancer](https://onco.cc/key-papers/paper-catalona-psa-screening-test-nejm-1991/), [Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005](https://onco.cc/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/)
- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- terms: [Biochemical recurrence (BCR)](https://onco.cc/terms/biochemical-recurrence/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [Radical prostatectomy](https://onco.cc/terms/prostatectomy/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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