Screening for prostate cancer

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Prostate cancer is the second leading cause of deaths resulting from cancer. Every year, approximately 29,000 men die in the U.S. from prostate cancer. Early detection with routine prostate cancer screening followed immediately with appropriate treatment could prevent many of these deaths. The failure on the part of some doctors to recommend routine prostate cancer screening to their male patients or to follow up on abnormal test results may result in a medical malpractice claim.

Screening for prostate cancer

Cancer specialists generally recommend that all men between the ages of 50 and 75, even those without any symptoms, should be screened for prostate cancer. Men with a single first degree relative (such as a father, brother, or son) diagnosed with prostate cancer before age 65, or of African-American descent, are at higher risk and should be screened starting at age 45. Men with multiple first-degree relatives diagnosed with prostate cancer at an early age are at even higher risk and should begin screening at age 40. Screening for prostate cancer consists of yearly:
- digital examination and
- PSA test
The digital examination is performed by briefly inserting a gloved, lubricated finger into the rectum to feel the back wall of the prostate. This procedure allows a doctor to check for the presence of nodules in the prostate.

The PSA test is a blood test that measures the amount of prostate specific antigen, an enzyme that is produced by the prostate and released into the blood stream. An elevated level of this enzyme could indicate the presence of prostate cancer. Generally, PSA test results in the range of 0-4 are considered to be within the normal range for most men. These numbers can be further refined by such factors as the patient’s age.

An abnormal digital examination or a PSA test result higher than 4.0 should raise the suspicion that prostate cancer may be present. When this happens, the patient should, at a minimum, be advised of the possibility that the abnormal test results might indicate the presence of cancer and of options for further testing, such as a TRUS guided biopsy, to confirm whether prostate cancer is present.

The progression of the prostate cancer is tracked through stages

Once prostate cancer is diagnosed, the progression of the cancer is categorized by a four-level staging system:
- Stage 1 (also known as Stage A): The cancer is not palpable to the touch.
- Stage 2 (also known as Stage B): The cancer is palpable but is confined to the capsule.
- Stage 3 (also known as Stage C): The cancer is palpable and has spread outside the capsule, but no further than the seminal vesicles.
- Stage 4 (also known as Stage D): The cancer is palpable and has spread to the bone or other organs.

Prostate cancer treatment and prognosis

If prostate cancer is detected while it is still confined to the capsule, there is a very good chance that, unless it is an extremely aggressive form of prostate cancer, it is curable. There are various treatment options when prostate cancer is detected while still in stage 1 or stage 2, including surgery (radical prostatectomy) and radiation therapy (either external beam therapy or interstitial therapy). Statistically, over 90 percent of men whose prostate cancer is detected before it spreads outside the capsule are still alive 5 years after diagnosis. These statistics are lower for very aggressive forms of prostate cancer.

When prostate cancer spreads outside the capsule, it is not longer considered curable. At this point, prostate cancer is at best merely treatable. Treatment options may include hormone therapy, radiation therapy, orchiectomy (the surgical removal of the testicles), and possibly chemotherapy. 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.

Failure to screen for prostate cancer may constitute medical malpractice

Unfortunately, some doctors do not recommend routine prostate cancer screening to their patients. And some doctors ignore abnormal digital examination results and elevated PSA results when they do PSA screening. By the time the cancer is discovered - often because the patient sees a different doctor who finds nodules during a digital examination or notices a highly elevated PSA, or the patient starts to feel lower back, hip pain, or other symptoms - the prostate cancer has already advanced to a Stage 3 or even a Stage 4. The prognosis is now much different for this individual than it would have been had the prostate cancer been detected early through routine prostate cancer screening. In effect, as a result of the failure on the part of the doctor to advise the individual to undergo routine screening, or to follow up on an abnormal digital examination or an elevated PSA test result, the prostate cancer is now much more advanced and the individual has a much reduced chance of surviving the cancer. In medical malpractice terms, this is referred to as a “loss of chance” of a better recovery.