subject: Even With High PSA Levels Man's Doctors Fail To Diagnose His Prostate Cancer [print this page] Even With High PSA Levels Man's Doctors Fail To Diagnose His Prostate Cancer
Doctors use diagnostics tests to doctors to determine if a patient has the cancer. Still because of the possibility of false negatives (a negative test outcome even though the patient in reality has cancer) physicians have to follow up and redo tests as appropriate when patient complaints and screening tests continue to indicate the possibility of cancer. The failure to do so might leave the doctor liable for malpractice.
In one published case a man told his primary care physician that he was having urinary frequency and burning. The doctor commenced him on antibiotics and refered the man to a urologist. The urologist did a cystoscopy which showed that the individual had an enlarged prostate. The urologist also took a PSA blood test which registered a 16.3 (anything higher than a 4.0 is ordinarily accepted as high). As a result the urologist took a biopsy two months later. The biopsy was read by a pathologist as benign.
The next year the individual went back to the urologist. On this occasion the PSA registered a 2.9 (typically considered to be normal). The urologist diagnosed the patient with BPH (a benign enlargement of the prostate). After 3 months the individual went to the primary care physician with complaints of fever and nocturia (having to urinate during the night). The physician put him on a second round of antibiotics. A follow up urine culture registered negative. The primary care physician thus referred the patient to the urologist. The urologist ordered a PSA test which registered a 6.4 ( high).
A biopsy examines parts of the prostate. As a result, a biopsy can miss the cancer. But, the urologist chose to depend on the preceding year's biopsy and to not perform an additional one as a follow up. Instead, the urologist did nothing to follow up on the man's complaints and abnormal PSA. The following year the individual returned to his primary care physician. His symptoms continued to include nocturia. On physical examination the physician documented that the patient had a very enlarged prostate. Yet, the doctor did not do another a PSA or re-refer him to a urologist. Regular blood testing 4 months afterwards revealed that the male patient's PSA was at 7.4 Neither physician did anything to follow up.
The next year the primary care physician noted that the PSA level was 9.8 Again, no follow up or referral to a urologist. Yet one more year and the man continues to have problems with nocturia. Now the PSA was 9.7 No follow up and no referral. Five years after the person's initial claims of urinary problems the primary care physician once more documented a substantially enlarged prostate gland and a PSA level that had reached a 31. The doctor lastly refered the individual back to the urologist.
The urologist confirmed that the patient's prostate was enlarged and started the man a two week regimen of antibiotics to be followed by another PSA test. When the PSA test was repeated 2 weeks soon after it registered a level of 33. A biopsy followed which uncovered cancer every sample taken.
Testing later found that the man had prostate cancer which had spread to the lymph nodes, the liver and the bone. Even after hormone therapy and radiation therapy the patient died close to 18 months subsequent to his diagnosis. The law firm that represented his family announced that a settlement for $1,000,000 was attained in the case.
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