Doctors use the PSA (Prostate Specific Antigen) blood test as one way to screen men for prostate cancer. Prostate cancer tends to raise the PSA level in the bloodstream as the cancer progresses. Doctors generally consider a PSA above 4.0 ng/mL to be elevated and thus recommend that an elevated PSA result should be followed by a TRUS guided biopsy in order to rule out prostate cancer.
Elevated PSA test results can, however, be caused by factors other than cancer, such as inflammation of the prostate or infection. Such elevated PSA readings are called "false positives." There are also potential risks associated with biopsies, such as excessive bleeding and infection. Citing the possibility of false positive PSA results and the risks associated with biopsies, some doctors take a "watchful waiting" stance, whereby a male patient's elevated PSA is monitored over the course of several months or years. They may also recommend trying treatments such as medication for infection to see whether such treatment lowers the PSA back to normal levels.
One of the problems with this approach is that a doctor may wait too long before recommending a biopsy. As the PSA rises the likelihood increases that the rising levels are due to prostate cancer, as does the likelihood that the cancer has spread beyond the capsule. Men with prostate cancer who have a PSA concentration less than 10 ng/mL have a 70 to 80 percent chance of having organ-confined disease, compared to 50 percent for those with PSA levels 10 to 50 ng/mL, and only 25 percent with higher PSA levels
If prostate cancer is detected while still contained within the capsule, the patient's 5 year survival rate will generally be above 90 percent. The statistics are lower for the most aggressive forms of prostate cancer. The 5 year survival rate is a statistical indicator of the percentage of patients who survive the disease for at least five years after diagnosis. Treatment for early stage prostate cancer includes surgery (radical prostatectomy) to remove prostate. Other options include radiation therapy (either external beam therapy or interstitial therapy). Given high 5 year survival rates associated with early state prostate cancer, it is generally considered curable when diagnosed and treated early.
When prostate cancer spreads outside the capsule, it is not longer considered curable. At this point, prostate cancer is at best merely treatable. In general, men whose cancer has already reached stage 3 by the time they are diagnosed have about a 50-50 percent chance that the cancer will progress. When the prostate cancer is already at stage 4 and has reached the bone or other distant organ at the time of diagnosis, the patient generally only has a 2-3 year life expectancy.
If the prostate cancer is not detected until it has spread beyond the capsule, a patient has about a 50-50 percent chance that the cancer will progress. If the cancer spreads to the bone or to distant organs by the time of diagnosis, the patient generally has only a 2-3 year life expectancy. Treatment options may include hormone therapy, radiation therapy, orchiectomy (the surgical removal of the testicles), and possibly chemotherapy. In time, treatment may cease to be effective if the cancer continues to progress. When treatment ceases to be effective, prostate cancer is fatal. This year, approximately 90,000 men will die in the U.S. from advanced prostate cancer.
This is why doctors generally recommend that a biopsy should be ordered if a male patient's blood test shows a PSA level above 4.0 ng/ml. A biopsy is a procedure, normally performed under local anesthesia, whereby a probed is inserted into the rectum. The probe contains a needle which is used to take samples of the prostate tissue. Because the biopsy consists of samples, it is possible that the biopsy may yield a false negative, missing the cancer. This is why doctors generally recommend that biopsies be repeated every few months if the PSA levels remain elevated, even after treatment for other possible causes.
By taking a "watchful waiting" approach and monitoring a male patient's elevated PSA, a doctor puts the patient at risk of not knowing he has prostate cancer until it progresses to an advanced, possibly untreatable, stage. This may constitute a departure from the accepted standard of medical care and may result in a medical malpractice claim.
Contact a Lawyer Today
If you or a family member have been diagnosed with Stage 3 or Stage 4 prostate cancer after a doctor recommended "watchful waiting" with a continually elevating PSA, you need to contact a lawyer immediately.
This article is for informational purposes only and is not intended to be legal (or medical) advice. You should not act, or refrain from acting, based upon any information at this web site without seeking professional legal counsel. A competent lawyer who is experienced in medical malpractice can help you determine if you have a claim for the delay in the diagnosis of the prostate cancer. Do not wait to contact a lawyer as are there is a time limit in cases like these.
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