Prostate Cancer Diagnosed Too Late in a Patient With Strong Family History for the Disease

prostate cancerThis case involves a forty-four-year-old male with a known family history of prostate cancer. The patient alerted his family physician to his family history of prostate cancer and the physician noted that the patient’s father died from prostate cancer. The patient requested that he be thoroughly screened and routinely monitored for PSA levels and prostate screenings. The physician agreed that an appropriate level of monitoring was required for this patient, given his family history. The patient’s PSA values were 1.9 at the time of the first lab studies. The following year, his PSA values elevated to 3.6 – which his physician advised was nothing to be worried about – and insisted that he’d continue to order PSA values for the man at annual physicals. The following year, unbeknownst to the patient, no PSAs were ordered – yet when the man spoke with the physician at his appointment, he was advised that they were, and that the values were in normal range. This happened again one year later and the patient was once again misinformed, and he was advised that the PSA values were within normal range. Finally, after 3 full years had passed, the physician actually ordered PSA values for the man, and they were well above 12. The man received a thorough work up and was diagnosed with metastatic disease, which ultimately killed him less than two years after the time of diagnosis.

Question(s) For Expert Witness

  • 1. Can you determine with a fair degree of medical certainty that if this man had been worked up and diagnosed with prostate cancer in a more timely fashion (ie: 3 years earlier), that his condition would have been highly treatable, if not curable?

Expert Witness Response E-004710

While the value of PSA for routine population screening is hotly debated, the individual factors in this case indicated PSA screening and the provider agreed. Prostate cancers in this age group and demographic (family history, etc.) is usually aggressive, as it turned out to be once diagnosed, and diagnosing it at an early stage would make it curable, with a fair degree of medical certainty. It certainly seems likely this man (based on his family history) deserved more thorough monitoring and the levels described also suggest that the physician had plenty of time to manage this. It would be difficult to argue that earlier intervention and diagnosis for this patient would not have resulted in a better outcome.

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