Delayed Diagnosis of Prostate Cancer
Prostate cancer is the most common cancer in men and the incidence of prostate cancer increases as men age.
Earlier detection of prostate cancer is possible with a simple blood test known as a PSA (prostate-specific antigen) test. An abnormal PSA level (e.g. >4 ng/mL) and/or abnormal digital rectal examination findings (e.g. asymmetry, nodule, firmness) are indications for prostate biopsy. The likelihood of finding cancer on a prostate biopsy increases with higher PSA values.
Prostate biopsy is uniformly recommended in men whose serum PSA is greater than10 ng/mL, since the chance of finding prostate cancer is over 50 percent.
Prostate biopsy is the "gold standard" for the diagnosis of prostate cancer diagnosis. Needle biopsy of the prostate under ultrasound guidance is the only accepted standard of care for performing a prostate biopsy.
Survival of prostate cancer is related to disease extent and histological classification at the time of diagnosis. When detected in its early stages, prostate cancer can be effectively treated and cured. Early detection of prostate cancer can make a difference in the patient's prognosis. Studies have demonstrated that organ-confined prostate cancer is a curable disease in the majority of men.
Prostate cancer staging is done by TNM classification. The specifics of this method of staging are more fully set forth in the American Joint Committee on Cancer - Cancer Staging Manual, Sixth Edition
http://www.cancerstaging.org/staging/PDFs/tnm_prostate_08.pdf.
Prostate cancer is graded according to differentiation by the Gleason score. To determine a Gleason score, a pathologist microscopically examines the biopsied tissue samples and determines where the cancer is the most prominent (the primary grade) and then where it's next most prominent (the secondary grade). A score from 1 to 5 is assigned to the primary grade and then to the secondary grade. The Gleason score is the sum of the primary and secondary grades. The total score can be from a 2 (1 + 1) to a 10 (5 + 5).
Studies have demonstrated that the Gleason score provides extremely important information about prognosis and can be the single most important predictor of death from prostate cancer. The higher the Gleason score, the worse the prognosis. Generally, prognosis by Gleason score is divided into four groups:
- 2 to 6, with the tumor confined to the prostate;
- 2 to 6, with the tumor extending through the prostate capsule;
- 7; and
- 8 to10
When a health care provider's malpractice causes a delay in the diagnosis and treatment of prostate cancer and that delay results in the patient being in a higher Gleason score group, the patient's prognosis is worse and the health care provider may be held liable for the resulting damages.
