subject: Five Years Of Symptoms And Abnormal Test Results Before Doctor Diagnosed Patient's Prostate Cancer [print this page] Doctors use diagnostics tests to doctors to verify if the cancer is present in a patient. Yet with the prospect of false negatives (a negative test outcome although the patient actually has cancer) doctors need to follow up and repeat tests as appropriate when patient symptoms and screening tests keep showing the possibility of cancer. The failure to do so may give rise to a lawsuit for medical malpractice.
In one recorded claim a man communicated to his primary care doctor that he was suffering from urinary frequency and burning. The physician commenced him on antibiotics and referred the man to a urologist. The urologist conducted a cystoscopy which showed that the patient had an enlarged prostate. The urologist additionally ordered a PSA blood test which registered a 16.3 (a level over a 4.0 is normally thought to be abnormal). Consequently the urologist performed a biopsy two months later. The biopsy was read by a pathologist as containing no evidence of cancer.
The subsequent year the individual returned to the urologist. On this occasion the blood test registered a 2.9 (normally regarded as normal). The urologist concluded that the individual had an enlarged prostate. Three months later the man went to the family doctor with complaints of fever and nocturia (having to urinate during the night). The physician started him again on antibiotics. A follow up urine culture showed up negative. The PCP hence referred the individual back to the urologist. The urologist did a blood test which came back a 6.4 (again, high).
A biopsy analyzes portions of the prostate. Thus, a biopsy can miss the cancer. But, the urologist decided to rely on the preceding year's biopsy and to not perform another one as a follow up. Instead, the urologist failed to do anything further about the man's complaints and high PSA.
A year later the man returned to his primary care physician. Complaints continued to include nocturia. On physical examination the physician documented that the patient had a very enlarged prostate. Nevertheless, the doctor did not order a blood test or re-refer him to a urologist. Routine blood testing four months subsequently revealed that the man's blood test result was at 7.4 Neither doctor followed up in any way.
The next year the family doctor recorded that the level was 9.8 Once more, no follow up or referral to a urologist. Still another year and the patient continues to have problems with nocturia. Now the level was 9.7 No follow up and no referral. Five years after the person's initial complaints of urinary problems the primary care physician once more recorded a substantially enlarged prostate gland and a PSA that had now risen to 31. The physician lastly referred the patient back to the urologist.
The urologist confirmed that the patient's prostate was enlarged and placed the man on 2 weeks after which he would do an additional PSA test. Once the test was done two weeks later it registered a 33. A biopsy followed which found cancer every sample taken.
Testing subsequently showed that the patient had cancer metastasis to the lymph nodes, the liver and the bone. Even after a course of hormone therapy and radiation therapy the man died nearly 18 months after his diagnosis. The law firm that represented his family published that the matter settled for $1. Million.
