Was lack of regular PSA testing to blame?
A 49-YEAR-OLD MAN HAD A PARTIAL PHYSICAL EXAM and a prostate-specific antigen test. He complained of urinary problems, including frequent urination and a weak stream. The patient didn’t complete the second part of the exam.
Five months later, he scheduled a follow-up and acute care visit, at which time he complained of rectal bleeding. The doctor performed a digital rectal exam, which revealed an enlarged prostate. He didn’t discuss further PSA testing or follow-up on the previous urinary complaints. He referred the patient to a gastroenterologist.
Six months after the second visit, the patient called to ask about some blood work, including a test for diabetes. The physician ordered a fasting blood sugar test. About a year after that, the patient saw his doctor for a sore throat. The doctor ordered lipid panels, thyroid-stimulating hormone tests, and liver enzyme tests. He didn’t order or discuss PSA testing.
Seventeen months later, the patient was diagnosed with stage 4 prostate cancer, which had metastasized to the brain, lungs, spine, and bony extremities. Various treatment protocols failed to help. By the time of arbitration, the patient had been given fewer than 2 weeks to live.
PLAINTIFF’S CLAIM The plaintiff should have had more regular PSA testing.
THE DEFENSE The PSA test done at the time of the initial physical examination was sufficient; even if the patient had been diagnosed at the second doctor visit 5 months later, his chance of survival would have been less than 50%.
VERDICT $3.5 million California arbitration award.
COMMENT Evidence? What evidence? Here is an arbitration award of $3.5 million for failure to perform PSA testing regularly in a 49-year-old. Although this account is incomplete, remember that the courts are sometimes impervious to evidence-based medicine.