Benefits of PSA Test Are Exaggerated

It seems to me that the massive studies of the effectiveness of PSA screening (and mammography) avoid a very important aspect --- studying the path from PSA screening to outcome. Along this path one encounters biopsy, pathology report,possible multiple consultations, treatment decision, etc and all of these effect the outcome. What I would like to know is what happens when the best choices are made along the path. If one goes to an excellent prostate center, gets multiple opinions, etc will this change the outcome from one averaged over all sorts of practitioners, to results using good practitioners, will this change the apparent effectiveness of screening (PSA or mammography)? Inadequate choices would degrade the benefits of screening wouldn't they? For example a report just came out of Memorial Sloan Kettering that describes significant lacks in the experience of many who performed prostate cancer surgery, apparently leading to poorer outcome. The statistical studies would attribute this to screening when it should be attributed to poor choice of surgeons. What we need are studies of the best ways to deal with screening results, which after all do tell us something even if uncertain, rather than being advised to simply not do it so as to avoid possible lack of good treatment following the screening.

Lee Smith of NY 8:29AM December 07, 2009