Prostate cancer is a terrible disease. Although not perfect there are diagnostic tests that assist doctors to figure out whether the cancer is present in a patient. However because of the prospect of false negatives (a negative test result while the patient in reality has cancer) physicians need to follow up and repeat tests as appropriate when patient symptoms and screening tests continue to suggest the possibility of cancer. The failure to do so may leave the doctor liable for malpractice.
In one documented case a patient told his primary care doctor that he was experiencing urinary frequency and burning. The doctor commenced the man on antibiotics and refered the man to a urologist. The urologist conducted a cystoscopy which found that the individual had an enlarged prostate. The urologist also took a PSA blood test which registered a 16.3 (a result higher than a 4.0 is normally thought to be abnormal). Therefore the urologist did a biopsy 2 months later. The biopsy was read by a pathologist as benign.
The next year the individual went back to the urologist. This time the PSA came back a 2.9 (generally regarded as normal). The urologist diagnosed the patient with BPH (a benign enlargement of the prostate). Three months later the patient consulted the primary care physician for fever and nocturia (having to urinate over the night). The physician began him again on antibiotics. A follow up urine culture came back negative. The primary care physician consequently referred the man to the urologist. The urologist took a PSA test which came back a 6.4 ( high).
A biopsy analyzes portions of the prostate. As a result, it is possible for a biopsy to miss the cancer. But, the urologist chose to rely on the preceding year’s biopsy and to not do an additional one as a follow up. Rather, the urologist failed to follow up on the patient's complaints and high PSA. The next year the man returned to his family doctor. Complaints including nocturia persisted. On physical examination the physician noted that the patient had a very enlarged prostate. But, the doctor did not order a PSA or re-refer the patient to a urologist. Standard blood testing 4 months subsequently revealed that the male patient's PSA was at 7.4 Neither doctor followed up in any way.
One more year goes by at which time the family doctor recorded that the PSA level was 9.8 Again, no follow up or referral to a urologist. Still one more year and the individual continues to have problems with nocturia. On this occasion 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 recorded a substantially enlarged prostate gland and a PSA that had reached a 31. The doctor finally refered the patient back to the urologist.
The urologist verified that the patient’s prostate was enlarged and began the man a two week regimen of antibiotics to be followed by one more PSA blood test. After the PSA test was repeated 2 weeks afterwards it recorded a level of 33. A biopsy was then at last done which found cancer in all 6 of the samples.
Testing later uncovered that the patient had cancer metastasis to the lymph nodes, the liver and bone. Even after both hormone therapy and radiation therapy the individual passed away approximately 18 months after his diagnosis. The law firm that handled this matter recorded that a settlement in the amount of $1,000,000 was reached in the case.
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