A 62-year old Floridian was referred to a urologist by his primary care physician for evaluation of an elevated PSA.
In the documentation of the first visit the urologist noted the elevated PSA, but not plan was set for prostate biopsy.
Approximately 4 months later the patient returned to the urologist with an unchanged repeat PSA. Again, no biopsy was performed.
The patient returned to his primary care physician about a year after the initial urology referral and was noted to have an increase to his already elevated PSA. The primary care physician re-referred the patient to the urologist, at which time a biopsy was then performed confirming aggressive, metastatic, incurable prostate cancer.
While undergoing treatment for the metastatic prostate cancer the patient committed suicide, citing the grueling nature of the treatment.
A malpractice suit was filed on behalf of the man’s estate alleging negligence due to failure to perform a biopsy with an elevated PSA. The plaintiff’s side argued that had a biopsy been performed earlier the disease could have been caught before it had become so aggressive and wide-spread.
The urologist argued that he recommended a biopsy at each visit, but that the patient declined further evaluation because of a bad experience with a prior negative prostate biopsy. Additionally, the defendant argued that the prostate cancer was already metastatic upon initial presentation and that earlier biopsy would have resulted in no significant change in outcome.
After a 10 minute deliberation the jury returned a verdict in favor of the defense.
The key takeaway from this case is the importance of documenting not only pertinent positives and treatments provided, but also documenting recommended treatments that were declined. This is particularly important in patients with elevated PSA who decline biopsy due to concerns about infection, pain, or prior negative experiences.