{"entity":{"id":"paper-stamey-psa-serum-marker-nejm-1987","kind":"paper","name":"Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate","aka":["Stamey 1987","PSA serum marker 1987"],"tldr":"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.\n\nProstate-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.","asOf":"2026-09-25","links":[{"label":"N Engl J Med 1987","url":"https://doi.org/10.1056/nejm198710083171501"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/2442609/"}],"tags":["prostate-evidence"],"related":["paper-catalona-psa-screening-test-nejm-1991","paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009","prostate-roadmap"],"cancers":["prostate","prostate-low-risk","prostate-intermediate-risk","prostate-high-risk"],"sections":["diagnostics","early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["psa","biochemical-recurrence","prostatectomy"],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-overdiagnosis","b-biomarker-validation"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":1987,"doi":"10.1056/nejm198710083171501","pmid":"2442609","authors":"Stamey TA, Yang N, Hay AR, et al.","paperType":"observational","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."],"whatItMeans":"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."],"changedPractice":true,"participants":699},"route":"/key-papers/paper-stamey-psa-serum-marker-nejm-1987/","neighbours":{"paper":[{"id":"paper-catalona-psa-screening-test-nejm-1991","kind":"paper","name":"Measurement of prostate-specific antigen in serum as a screening test for prostate cancer","route":"/key-papers/paper-catalona-psa-screening-test-nejm-1991/"},{"id":"paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009","kind":"paper","name":"Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005","route":"/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/"}],"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/prostate-roadmap/"}],"cancer":[{"id":"prostate-high-risk","kind":"cancer","name":"Localised prostate cancer, high and very high risk","route":"/cancers/prostate-high-risk/"},{"id":"prostate-intermediate-risk","kind":"cancer","name":"Localised prostate cancer, intermediate risk","route":"/cancers/prostate-intermediate-risk/"},{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"},{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"term":[{"id":"biochemical-recurrence","kind":"term","name":"Biochemical recurrence (BCR)","route":"/terms/biochemical-recurrence/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"prostatectomy","kind":"term","name":"Radical prostatectomy","route":"/terms/prostatectomy/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}