"Watchful Waiting" Advice May Lead To Delayed Diagnosis Of Prostate Cancer

The PSA blood test is used by doctors to screen asymptomatic men for prostate cancer. A PSA above 4.0 ng/mL is generally considered to be elevated. Since prostate cancer increases the PSA level as the cancer progresses doctors generally recommend a biopsy if the PSA test comes back abnormally high.

When a factor other than prostate cancer causes the PSA level to raise the elevated PSA is called a “false positive.” A biopsy has risks, such as the risk of infection and the risk of excessive bleeding. Given these two facts some doctors advise that their male patients follow a plan of “watchful waiting.” Under such a plan the doctor monitors the patient’s elevated PSA over a period of months or years. During this time some doctors also advise that the patient try non cancer related treatments, for example, for infection, under the theory that if the PSA is elevated for a reason other than prostate cancer such treatments may bring the PSA back to normal levels.

The danger with doing this is that the physician may wait too long before ordering any tests to determine whether the high PSA level is due to prostate cancer. If waiting results in the spread of the cancer beyond the prostate capsule then the patient will no longer have treatment options that can eliminate and cure the cancer. For patients whose cancer is detected while contained within the capsule, the likelihood is better than 90 percent that they will still be alive 5 years after diagnosis. The percentage is lower for the most aggressive forms of prostate cancer. This measure is referred to as the 5-year survival rate.

After the cancer spreads beyond the capsule, the 5-year survival rates drop significantly. In general, once the cancer reaches to stage 3 the patient has about a 50-50 percent chance that the cancer will progress. If the cancer is already at stage 4 when the diagnosis is made, the patient generally only has a 2-3 year life expectancy.

Treatment options for advanced prostate cancer may include hormone therapy, radiation therapy, orchiectomy (the surgical removal of the testicles), and possibly chemotherapy. Treatment will usually cause the PSA to drop significantly. Over time, however, treatment ceases to be effective as the cancer continues to progress. This is typically associated with a new rise in the PSA level. After the treatment stops being effective, the cancer is fatal. As of the time this article was written approximately 27,000 men a year are expected to die in the U.S. from advanced prostate cancer.

How many of these 27,000 deaths will be due to a physician advising his patient to follow a plan of “watchful waiting” and then waiting too long to finally diagnose the cancer? We might never know how many of these men’s lives might have been saved had the physician instead advised the patient to undergo a biopsy.

However, if you or a member of your family were among those whose physician delayed the diagnosis of prostate cancer until it was at an advanced stage, you should immediately contact a competent medical malpractice attorney. The physician may be liable under a medical malpractice claim.

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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