Men frequently possess a poor comprehension of prostate cancer, their own risk for the cancer, and the methods available for detecting whether they have prostate cancer. Many men have little, if any, understanding of the value of screening for prostate cancer or of the guidelines for when they should commence testing, how frequently to screen, and the meaning of screening test results. Regrettably doctors sometimes fail to screen male patients or wait too long prior to ordering diagnostic testing subsequent to an abnormal result from a screening test.
There are several various factors that can result in a delayed diagnosis. One common type of medical error that forms the basis for these cases comes about when the male patient’s primary care physician (1) orders a PSA blood test, (2) notices abnormally high levels of PSA and but (3) neither tells the patient about the abnormal results (and what they indicate) nor orders diagnostic tests, such as a biopsy, to rule out prostate cancer. The case below is an example of this problem.
A doctor, an internist, discovered that his male patient had a PSA of 8. (a level above a 4.0 is generally thought to be high). The doctor did not tell the patient. The physician failed to refer the patient to a urologist. The doctor failed to order a biopsy. Two years later the doctor repeated the PSA test. This time the PSA level had risen to 13.6. Once again, the doctor did not inform the patient. Again, the doctor did not refer the patient to a urologist. And again, the doctor did not order a biopsy. Two years later the physician repeated the PSA test. It was not until three years after first knowing about the patient’s raised PSA level that the doctor finally told him that he most likely had cancer. More testing showed that at this point he had advanced prostate cancer. A prostatectomy was no longer an option. Rather the patient underwent radiation therapy and hormone therapy in an effort to impede the further progression of the cancer. The law firm handling this matter announced that the case went to mediation and settled in the amount of $600,000.
But doing nothing after observing abnormal test results results in 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 lessening the chances that the patient will be able to survive the cancer.
This lawsuit illustrates a sort of mistake that can result in the delayed diagnosis of a patient’s prostate cancer. It occurs when the physician actually follows the guidelines and screens male patients for prostate cancer yet does not follow through when the test results are abnormal.