Steven E. North, Esq.

Physicians should be alerted that failure to perform a PSA test during a comprehensive physical examination of a man older than 60 can have serious malpractice liabilities. If an untested patient later presents a more advanced cancer that could have been nipped in the bud by earlier diagnosis and treatment, the physician can be exposed to a claim of medical malpractice.

The risk of a PSA test is limited to a potential reaction from taking a small blood sample for evaluation. The incidence of infection or serious hematological consequences from this test is nil. Its value is the potential identification of prostate cancer that can be treated, saving lives.

PSA results do not definitively signify the presence of cancer, but it is agreed that they are reasonably reliable. That is why certain outcomes may prompt a physician to suggest a biopsy to further evaluate the condition. Infection stemming from a biopsy, however, is more prevalent than it is from a blood test.

It is hard to imagine anyone preferring not to know whether or not he has cancer, but ultimately, the biopsy-or-not decision falls to the patient under the guidance of his physician, with the knowledge that the PSA does in some instances yield false positives or negatives.

Danger for both physician and patient lurks in the treatment decision made once cancer is identified. Physicians may recommend, or a patients may demand, aggressive treatment in some instances when watching and waiting may be the most appropriate choice.

The standard of care with regard to PSA is somewhat fuzzy, and the best-practices pendulum has swung wide as new research is completed. However, physicians should be alerted that failure to perform a PSA test during a comprehensive physical examination of a man older than 60 can have serious consequences. If an untested patient later presents a more advanced cancer that could have been nipped in the bud by earlier diagnosis and treatment, the physician can be exposed to a claim of medical malpractice.