When does the PSA controversy lead to medical malpractice claims?

Steven E. North, Esq.

Prostate cancer kills. The early diagnosis of that condition can save lives. The traditional way to monitor and manage a man’s prostate cancer risk is the Prostate-Specific Antigen (PSA) screening, a simple blood test that serves as a reliable guide. The results indicate whether a person’s PSA value is above the accepted norm or whether the relative increase in value over a short period of time is more than it should be.

Some relatively recent studies, however, recommend against routine PSA screenings.
While there are legitimate concerns that a prostate biopsy should not be taken lightly, the initial information from a PSA test is still the accepted standard of care. Further, we believe that studies are sometimes promulgated with the intent of saving money (cost of a routine PSA test) even though identifying the cancer early in some patients could mean the difference between life and death.

What people of that point of view fail to recognize and appreciate is that until PSA screening became the standard in the late 1980’s, more than half the men diagnosed with prostate cancer already had advanced disease that had metastasized to other parts of the body. One would think that nothing more need be said.

Nevertheless, these studies have influenced primary care physicians, some of whom are not screening patients as frequently as they used to. The bottom line, in our opinion, is that having or bypassing a PSA screening is a patient’s choice. If a doctor feels that the financial benefit outweighs the potential health risk, it is still the patient who should decide whether the simple blood test, the current standard of care, should be administered.

When the decision is to run the test and the results indicate high PSA values, there will be treatment considerations. For some, the best option may be “watchful waiting” for less aggressive cancers. For others, some form of radiation or surgery should be undertaken.

Medical malpractice cases concerning prostate cancer often do not center around when the PSA testing was or should have been done. Most often it is about the failure of a clinician to appreciate a significant abnormality and take action with respect to it. We have successfully litigated numerous prostate cancer cases in which, for apparently unexplained reasons other than simple carelessness, the physician failed to act on significantly abnormal results which led to the development of advanced prostate cancer.