Prostate cancer is a frightening disease. Even if not perfect there are diagnostic tests that assist doctors to identify when the cancer is present in a patient. Still because of the prospect of false negatives (a negative test result despite the fact that the patient in reality has cancer) doctors must follow up and redo tests as appropriate when patient symptoms and screening tests continue to indicate the possibility of cancer. The failure to do so might leave the doctor liable for malpractice.
In one recorded lawsuit a man told his doctor that he was having urinary frequency and burning. The physician commenced the man on antibiotics and referred him to a urologist. The urologist performed a cystoscopy which revealed that the man had an enlarged prostate. The urologist also took a PSA blood test which came back a 16.3 (a result above a 4.0 is ordinarily accepted as high). Therefore the urologist performed a biopsy 2 months later. The biopsy was interpreted by a pathologist as exhibiting no indication of cancer.
The subsequent year the individual went back to the urologist. Now the PSA was a 2.9 (generally accepted as normal). The urologist diagnosed the patient with BPH (a benign enlargement of the prostate). Three months later the individual consulted the primary care physician with symptoms of fever and nocturia (needing to urinate over the night). The physician commenced him on a second round of antibiotics. A follow up urine culture registered negative. The PCP hence referred the man back to the urologist. The urologist took a PSA test which came back a 6.4 (again, high).
A biopsy examines samples of the prostate. Consequently, a biopsy can not catch the cancer. However, the urologist chose to rely on the previous year's biopsy and to not perform another one as a follow up. Rather, the urologist failed to follow up on the man's complaints and high PSA. The next year the patient returned to his family doctor. Complaints including nocturia persisted. On physical examination the doctor noted that the man had a very enlarged prostate. Yet, the doctor did not do another a PSA or re-refer the man to a urologist. Standard blood testing 4 months later revealed that the male patient's PSA was at 7.4 Neither physician did anything to follow up.
The following year the family doctor noted that the PSA level was 9.8 Once more, no follow up or referral to a urologist. Still one more year and the individual is still complaining about nocturia. On this occasion the PSA was 9.7 No follow up and no referral. On the fifth yea following the male patient's first reports of urinary problems the primary care physician once more documented a considerably enlarged prostate gland and a PSA that had now risen to 31. The physician at last refered the individual back to the urologist.
The urologist confirmed that the patient's prostate was enlarged and began the patient a 2 week regimen of antibiotics to be followed by another PSA blood test. After the PSA test was done 2 weeks afterwards it showed a level of 33. A biopsy followed which found cancer in all six of the samples.
Testing eventually revealed that the man had cancer metastasis to the lymph nodes, the liver and bone. Regardless of a course of hormone therapy and radiation therapy the man died roughly eighteen months following his diagnosis. The law firm that handled this matter reported that the case settled for $1,000,000.
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