We analyzed the primary symptoms and clinical stage before and after 1988 when the prostate specific antigen (PSA) measurement was introduced in 491 patients with prostate cancer diagnosed in our hospital between 1976 and 1996. Most primary symptoms were related to problems with urination both before and after 1988. However, after PSA measurement became available, the number of patients referred to our hospital by non-urologists increased significantly. In contrast, the frequency of patients with stage D2 disease decreased significantly and the frequency of patients with early prostate cancer (stage A and B) did not increase. Few patients with prostate cancer had PSA levels of 4 to 10 ng/ml. We suggest that general use of PSA for prostate cancer screening by non-urologists does not contribute to the early detection of prostate cancer, most likely because few patients with prostate cancer have low PSA levels.