How Malpractice Cases Might Allege Metastatic Prostate Cancer Due To Holdup From Watchful Waiting

23rd September 2010
By J. Hernandez in Medical Malpractice
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Physicians typically use two tests to screen male patients for prostate cancer. The thought is to diagnose the cancer early - before it has a chance to spread while treatment is likely to eliminate the cancer rather than wait until the cancer advances and spreads at which point there is currently no known cure. The first is a physical examination of the prostate gland for any abnormalities that might be the effect of prostate cancer. The second test is the PSA blood test which measures the amount of prostate specific antigen in the man's system. A PSA over 4. ng/ml is usually regarded as elevated. Because prostate cancer raises the PSA level when prostate cancer advances doctors generally recommend a biopsy when the PSA test registers high.

Raised PSA test results can, though, be brought on by variables different from cancer, like inflammation of the prostate or infection. This type of elevated PSA readings are known as “false positives.” A biopsy has known potential complications, like the danger of infection and the danger of excessive bleeding. Citing the possibility of false positive PSA results and the risks related to biopsies, some physicians take a “watchful waiting” position, whereby the man's high PSA is followed over the course of several months or years. They might additionally recommend going on medication for infection to see if the treatment reduces the PSA back to normal levels.

The problem with doing this is that the doctor might wait too long without doing any further tests to determine if the high PSA level is because of prostate cancer. As the PSA goes up the likelihood increases that the rising levels are caused by prostate cancer, as does the possibility that the cancer has metastasized. Men with prostate cancer who have a PSA concentration below 10 ng/mL have a 70 to 80 percent possibility of having organ-confined disease, compared to 50% for those with PSA levels 10 to 50 ng/mL, and only 25% with higher PSA levels

Treatment options for advanced prostate cancer may include hormone therapy, radiation therapy, orchiectomy , and maybe even chemotherapy. Treatment will usually cause the PSA to drop significantly for awhile. Eventually, 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. As of when this article was written roughly 90,000 men each year are expected to die in the U.S. from stage 4 prostate cancer.

This is why physicians normally advise that a biopsy ought to be done if a male patient’s blood test indicates a PSA level above 4. ng/ml. Because the biopsy only takes samples, it is possible that the biopsy might yield a false negative, missing the cancer. This is why doctors also generally recommend that biopsies be repeated every few months should the PSA levels stay elevated, even after treatment for other possible causes.

By taking a “watchful waiting” approach and just monitoring a male patient’s high PSA, a doctor places the patient at risk of letting time go by while the cancer progresses to an advanced, possibly untreatable, stage. The doctor might be liable under a medical malpractice claim.

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