Rising PSA, but no follow-up
CHEST PAIN PROMPTED A 48-YEAR-OLD MAN to visit his primary care physician. Blood work, including a prostate-specific antigen (PSA) test, revealed a slightly elevated PSA of 5.08. Five months later, the patient returned to the doctor complaining of a burning sensation on urination. Urinalysis and a digital rectal examination were normal. Laboratory test results included a PSA of 8.29. Nine months later the patient visited the physician for nonurologic complaints. Six months after that, when the patient had a complete physical because of a change in his insurance, his PSA was 17.11.
Subsequent testing revealed prostate cancer, and the patient underwent a non-nerve-sparing prostatectomy. A positron emission tomography scan done after the surgery showed an enlarged internal iliac lymph node, which indicated metastatic disease.
PLAINTIFF’S CLAIM The primary care physician was negligent in failing to follow up on the rising PSA values. The patient wasn’t informed of the PSA results.
THE DEFENSE The patient was informed of the abnormal test results (though it wasn’t charted). The patient would have had the same treatment, even with an earlier diagnosis, because he had a high Gleason score.
VERDICT $750,000 California settlement.
COMMENT Not charted = never happened. So many cases could be avoided if documentation was timely and complete!