Why Doctors Who Suggest Watchful Waiting May Risk A Medical Malpractice Case

Doctors ordinarily utilize two tests to test men for prostate cancer

. The idea is to detect the cancer in the early stages while treatment can be used to cure the cancer instead of waiting until the cancer advances and spreads and is no longer curable. The first is a physical examination of the prostate gland for any abnormalities that might be caused by prostate cancer. The second test is the PSA blood test which measures the amount of prostate specific antigen in the bloodstream. A PSA over 4. ng/ml is normally regarded as elevated. Since prostate cancer raises the PSA level as the prostate cancer advances doctors generally advice a biopsy when the PSA test comes back high.

When a factor other than prostate cancer causes the PSA level to rise the heightened PSA is called a false positive. A biopsy has risks, such as the danger of infection and the risk of significant bleeding. Given these two issues some doctors suggest that male patients use a strategy of watchful waiting. With this strategy the doctor monitors the man's elevated PSA during a time spanning of months or even years. During this time some physicians advise that the patient go on non cancer related treatments, for example, for infection, under the theory that when the PSA is high for a reason other than prostate cancer it is possible that the treatment could bring the PSA back to normal levels.

One of the problems with this approach is that a doctor may wait too long before suggesting a biopsy. As the PSA increases the likelihood increases that the rising levels are from prostate cancer, and so does the possibility that the cancer has metastasized. Men with prostate cancer who have a PSA concentration below 10 ng/mL have between 70 to 80 percent possibility of having organ-confined disease, compared to fifty percent for men with PSA levels 10 to 50 ng/mL, and just twenty five percent with higher PSA levels

In the event the prostate cancer is not found until it has spread beyond the capsule, a patient has roughly a 50% possibility that the cancer will progress. If the cancer metastaisizes to the bone or to distant organs by the time of diagnosis, the patient generally will survive for no more than two to three years. Treatment options might include hormone therapy, radiation therapy, orchiectomy (taking out the testicles), and perhaps chemotherapy. Over time, though, treatment ceases to be effective as the cancer continues to progress. This is typically associated with a new rise in the PSA level. When treatment ceases to be effective, prostate cancer is fatal. This year, an estimated 90,000 men will lose their lives in the U.S. from metastatic prostate cancer.

It is for this reason that doctors typically suggest that a biopsy should be done in case a man's blood test reveals a PSA level above 4. ng/ml. A biopsy is a procedure, normally done under local anesthesia, whereby a probe is inserted into the rectum. The probe contains a needle which is used to take samples of the prostate tissue. Because the biopsy only takes samples, a biopsy may give a false negative, thereby no finding the cancer. This is why physicians also ordinarily recommend that biopsies be redone if the PSA levels remain elevated, even after treatment for other possible causes.

However, if you or a member of your family were among those whose doctor delayed the diagnosis of prostate cancer until it was at an advanced stage, you should contact an experienced medical malpractice attorney right away. This might amount to a departure from the accepted standard of medical care and may end in a malpractice lawsuit.

by: Joseph Hernandez

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