Monday, February 20, 2012

When Doctors Do Not Follow Up After PSA Results Signal The Chance Of Prostate Cancer by Joseph Hernandez

Male patients frequently possess a poor knowledge of prostate cancer, their own chances for the cancer, and how to determine whether they have prostate cancer. Many men have little, if any, knowledge of the advantage of screening for prostate cancer or of the guidelines for when to start screening, how frequently to screen, and the meaning of screening test results. They put their confidence in their physician to do whatever is appropriate to detect any cancer early and cure them.

Delayed diagnosis of prostate cancer incidents are all too common. One typical medical mistake that is at the root of these cases arises when the male patient’s primary care physician (1) actually screens the individual for prostate cancer by tracking the amount of PSA (Prostate Specific Antigen) in his system, (2) finds abnormally high levels of PSA and but (3) does not inform the patient, does not refer the patient to a specialist, and fails to get a biopsy to confirm whether the elevated PSA is a result of prostate cancer. The lawsuit below illustrates this situation.

A physician, an internist, discovered that his male patient had a PSA of 8. (anything above a 4.0 is normally viewed as high). The physician did not inform the patient. The physician did not refer the patient to a urologist. The doctor did not order a biopsy. Two years later the doctor repeated the PSA test. This time it had gone up to 13.6. Again, the doctor said nothing to the patient. Again, the doctor did not refer the patient to a urologist. And again, the physician did not order a biopsy. Two years later the doctor repeated the PSA test. It was not until three years after first finding out about the patient’s elevated PSA level that the physician at last advised him that he probably had cancer. Further testing showed that at this point he had metastatic prostate cancer. A prostatectomy was no longer an option. Treating physicians alternatively recommended radiation therapy and hormone therapy. Neither of these would cure the cancer but they might impede the cancer’s advancement and further spread. The law firm handling this matter reported that the case proceeded to mediation and settled in the amount of $600,000.

But not following up after observing abnormal test results brings about a situation in which those patients who do actually have prostate cancer might not find out they have it until it has spread outside the prostate, decreasing the patient’s choices for treatment, and substantially reducing the chances that the patient will be able to survive the cancer.

As the above claim illustrates physicians sometimes comply with the guidelines by performing screening for prostate cancer yet when the test results are abnormal they fail to do anything about it.