Most prostate cancers are slow growing, so that the medical community has come to believe that for most people, the side effects of treatments outweigh any benefits that could come from treatment for most people. This does not mean that timely detection of certain prostate cancers do not benefit, even saving the lives of many men. The decision to not perform routine prostate screening means that some patients' cancers are missed, and they will die or suffer the serious effects of late diagnosis of their prostate cancers.
The American Cancer Society recommends that blood studies, the Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) should be offered each year to men, starting at age 50, if they have a > 10-year life expectancy. Certain men at high risk for developing prostate cancer, such as African American men or those who have a family history of prostate cancer, should begin testing at age 45.
The bottom line: Prostate examinations should be included routinely in examination of all high-risk patients, and they should at least be offered in yearly examinations of all other men over the age of fifty. However, if a patient experiences certain signs and symptoms, then additional examinations are in order.
Cursory History Taking: Prostate cancer may be accompanied by signs of problems, such as frequent urination, difficulty started urination, a weak or interrupted urine stream, erectile problems, and/or blood in the urine or semen. Every one of these symptoms may be caused by other problems, but still warrant additional investigations to rule out prostate cancer. Your medical provider should be asking questions to assess for any disturbance in voiding or sexual function, and performing appropriate diagnostic to identify the source of your problems.
Cursory Physical Examination: Prostate examinations should be included in all routine physical examinations for patients over the age of fifty (or younger if the patient is at a higher risk for developing cancer). To perform this exam, the examiner uses his gloved, lubricated index finger to feel the prostate gland at the same time he does the rectal examination, which should be performed to detect colon cancers. This is called a digital rectal exam or DRE, and it can pick up abnormalities of size, shape and texture that might differentiate between benign prostatic hypertrophy and cancers. If abnormalities are noted in this examination, additional diagnostic testing should follow. Early prostate cancers can be picked up during rectal examinations.
Misinterpretation of Diagnostic Studies: A test called the Prostate Specific Antigen or PSA is a blood study that can be done as part of a blood draw when other routine blood tests are run. It can detect prostate cancer. This test should be part of a normal examination of patients, who are at an elevated risk for developing prostate cancer. It can detect the recurrence of prostate cancer that has been treated already, or used in routine screening for men over the age of 50. (PSAs are not routinely performed unless you specifically request this test.)
Because the PSA goes up when patients have benign prostatic hyperplasia (BPH) or infections, interpretation of this blood test is not as simple as looking for a number that falls outside the normal range, (which is usually 0 to 4 ng/ml). Your doctor should also be comparing the test results from year to year to see if there is a significant change. A rapid rise in the test values may indicate prostate cancer.
Administrative errors: Lost test results, abnormal test results that get filed away unread or unheeded, failure to follow-up on inadequate or inconclusive examinations due to miscommunications, mislabeled specimens, etc., can result in a delay in diagnosis
Cost-saving measures: Some health plans give physicians financial incentives to not refer their patients to specialists or order diagnostic tests. If you are in a health maintenance organization or a health plan with "capitation" you are at risk from a doctor who is motivated to cut costs at the risk to your health.
To ensure timely diagnosis, the following guidelines should be followed:
Assessments should be thorough, accurate and complete;·
Every urinary or sexual complaint should be appropriately evaluated;
Prostate cancer screening guidelines should be adhered to;
Men with abnormal signs, symptoms, or lab values should have appropriate follow-up testing, and possibly a referral to a urologist who specializes in finding the cause of these problems;
Treatment plans should be made and follow- up interventions should be timely;
Documentation should include a thorough medical history and physical assessment, clinical impression, and follow- up plans.
Office tracking systems for cancer screening & testing follow-up should be utilized
The most common allegations of negligence in prostate cancer cases include your physician or medical provider's failures such as:
Delayed diagnosis of prostate cancer can lead to significant damages. In many cases, if the cancer had been diagnosed early and properly treated, you may have avoided the complications of treatment, such as debilitating surgeries, spread of disease that changes prognosis and chance of cure, life altering chemotherapy regimens and radiation regimens, severely diminished quality of life, or even death.
Prostate cancers often can be detected, and many of these cancers warrant treatment. Decisions about what screening should be done, what follow-up testing is indicated, and how to respond to abnormal findings should be tailored to the patient's situation. A complete and thorough medical history and physical examination, health maintenance plus appropriate supplemental diagnostic testing as indicated, with timely treatment plans and follow-up interventions can significantly improve a practitioner’s ability to avoid diagnostic errors, and give you care that is appropriate to your unique needs.
If you fear that substandard medical care or outright errors resulted in a delay in detecting your cancer, or caused complications in your cancer care that hurt your chance of recovering, I will look at your case free of charge, and tell you if you may have been the victim of medical malpractice. If your case is outside our jurisdiction, we can help you to find skilled and ethical counsel in your area.
Mark R. Bower, Esq
Law Offices of Mark R. Bower, PC