How Medical Malpractice Might Arise If Stage 4 Prostate Cancer Is Due To Delay From Watchful Waiting Recommendation

There are tests that allow the detection of some types of cancers, for instance prostate cancer, before the patient presents with symptoms. The thought is to detect the cancer early - before it is able to spread while treatment is likely to cure the cancer instead of waiting until the cancer advances and spreads and is no longer curable. The initial test is the digital examination. During this examination the doctor employs a gloved finger to physically examine the prostate gland for any signs of enlargement, hardening, or the presence of nodules, any of which could be a sign of cancer. The second test is the PSA blood test which calculates the amount of prostate specific antigen in the bloodstream. A PSA greater than 4. ng/ml is generally thought to be elevated. Since prostate cancer increases the PSA level when prostate cancer progresses physicians generally recommend a biopsy if the PSA test registers high.

When an issue other than prostate cancer causes the PSA level to rise the heightened PSA is termed a “false positive.” A biopsy has known potential complications, such as the danger of infection and the risk of significant bleeding. Citing the possibility of false positive PSA results and the risks related to biopsies, certain physicians take a “watchful waiting” stance, whereby the man's high PSA is followed over the course of several months or years. They might also suggest going on medication for infection to check whether such treatment reduces the PSA back to normal levels.

The threat with doing this is that the physician might let too much time pass before ordering any additional tests to determine if the high PSA level is due to prostate cancer. As the PSA goes up the probability increases that the rising levels are caused by prostate cancer, and so does the possibility that the cancer has spread beyond the capsule. Men with prostate cancer who have a PSA level lower than 10 ng/mL have a seventy to eighty percent chance of having organ-confined disease, compared to fifty percent for those with PSA levels 10 to 50 ng/mL, and only twenty five percent with higher PSA levels

Treatment options for advanced prostate cancer may include hormone therapy, radiation therapy, orchiectomy (the surgical removal of the testicles), and possibly chemotherapy. Treatment will normally lead to a major decrease in the PSA levels for some time. In time, treatment may stop working and the cancer will again continue to advanced. After the treatment stops being effective, the cancer again starts spreading and eventually kills the man. This year, an estimated ninety thousand men will die in the U.S. from advanced prostate cancer.

What percentage of these 90,000 deaths will be due to a physician counseling the manhis patient to stick to a plan of “watchful waiting” and then did nothing while the cancer spread? Perhaps we might never know how many of these men’s lives may have been saved had the doctor instead recommended the patient get a biopsy.

By taking a “watchful waiting” strategy and merely keeping track of a man's high PSA, a doctor puts the patient 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.

By: J. Hernandez

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Joseph Hernandez is an attorney accepting medical malpractice cases. To learn about prostate cancer and other cancer matters including colon cancer visit the websites