Doctor - Overlooking High PSA Might End Up In Malpractice Claim

Doctors typically employ two tests to test men for prostate cancer. The thought is to diagnose the cancer early - before it has a chance to spread while treatment can be used to cure 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 due to prostate cancer. The second test is the PSA blood test which measures the level of prostate specific antigen in the man's system. A PSA over 4. ng/ml is usually considered to be abnormal. Because prostate cancer increases the PSA level when prostate cancer advances doctors normally advice a biopsy when the PSA test registers high.

When an issue other than prostate cancer causes the PSA level to increase the elevated PSA is termed a “false positive.” A biopsy has risks, such as the risk of infection and the danger of significant bleeding. Citing the chance of false positive PSA results and the dangers related to biopsies, some doctors take a “watchful waiting” position, whereby the man's elevated PSA is followed over the course of several months or years. In this period of time a number of doctors advise that the patient try non cancer related treatments, for example, for infection, based on the theory that if the PSA is high for a reason other than prostate cancer the treatments may bring the PSA back to normal levels.

One of the issues with this approach is that a doctor might just wait too long before advocating a biopsy. 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 spread beyond the capsule. For patients whose cancer is detected while it is still only inside the capsule, the likelihood is more than 90% that they will still be alive 5 years beyond diagnosis. The number is lower for the most aggressive types of prostate cancer. This measure is called the 5-year survival rate.

If the prostate cancer is not diagnosed until it has spread beyond the capsule, a man has about a fifty percent possibility that the cancer will progress. If the cancer spreads to the bone or to distant organs by the time of diagnosis, the patient generally has just a two to three year life expectancy. Treatment possibilities may include hormone therapy, radiation therapy, orchiectomy (taking out the testicles), and perhaps chemotherapy. Eventually, though, treatment will no longer hold the cancer at bay. At this point the cancer will again commence spreading. This is typically associated with a new rise in the PSA level. Once the treatment no longer works, the cancer again starts spreading and eventually kills the man. As of the time this article was written roughly 90,000 men each year are expected to pass away in the U.S. as a result of prostate cancer metastasis.

This is why doctors generally recommend that a biopsy should be done in case a man's blood test shows a PSA level above 4. ng/ml. Because the biopsy consists of samples, it is possible that the biopsy may yield a false negative, thereby no finding the cancer. This is why doctors also ordinarily advise that biopsies be repeated if the PSA levels stay elevated, even after treatment for other possible causes.

By taking a “watchful waiting” strategy and just monitoring a male patient’s elevated PSA, a doctor puts the man in danger of not doing anything about the cancer until it gets to an advanced, possibly untreatable, stage. The physician may be liable under a malpractice claim.