Although there has recently been a certain amount of debate over what the standard of care should be in screening asymptomatic male patients for prostate cancer one factor remains constant: if the result of a screening test is abnormal the patient needs to be informed of the results and advised about the option for diagnostic testing such as a biopsy.
Should the doctor fail to do so the patient’s prostate cancer may spread and metastasize thereby become incurable before the patient becomes symptomatic and is finally diagnosed. That patient and his family may have a failure to diagnose medical malpractice claim against the doctor.
The digital examination of the prostate gland is one of the two tests routinely used to screen men for prostate cancer. The presence of a nodule or hardened area on the gland is an abnormal finding that could indicate cancer. Below are three examples of cases involving abnormal findings on a digital examination:
This case involved a 73 year old male patient whose PCP (primary care physician). Even though the patient did not have any symptoms of prostate cancer the PCP correctly performed the appropriate screening tests. The PPCP ordered PSA blood testing and performed a digital examination. The blood tests showed abnormally high levels of PSA. The digital examination revealed that the patient’s prostate was enlarged. Two signs pointed toward the possibility that the patient had prostate cancer.
Yet, the PCP did not inform his patient that the results of the blood test and the digital examination were abnormal and suspicious for cancer. The PCP likewise did not order any follow-up tests to rule out prostate cancer. By the time the patient was finally diagnosed the cancer had metastasized to the bone. The law firm that handled this case reported that they were able to achieve a recovery of $ 591,000 on behalf of the patient.
This case involved an internist who was seen by a patient complaining of urinary problems. The internist performed a digital examination and noted that the patient’s prostate gland was enlarged. The internist then ordered a biopsy. This is standard when there is an abnormal finding on the digital examination. The biopsy was performed at a local hospital. The pathologist who examined the biopsy samples documented in a written report that the samples contained prostate cancer. It took a year before the results were not communicated to the patient. The delay allowed the cancer to spread. It eventually took the patient’s life. The law firm that handled this case reported that the matter settled prior to trial for a confidential amount.
As both of these cases demonstrate it is not enough to comply with screening guidelines. Doctors must follow up when the results of screening tests come back as abnormal. Not doing so puts the patient at risk that he does in fact have prostate cancer and that the cancer will grow and spread to the point where it metastasizes and is no longer curable. If that happens the best that treatment can do is to slow down the spread of the cancer and eventually to minimize the effects (such as pain) of the cancer. All likely fully preventable if the doctor follows up on the abnormal screening test results.
Thus a doctor who does not follow up when, for example, a digital examination catches the presence of a nodule or hardened area on a patient’s prostate gland may be liable for medical malpractice.