Physicians ordinarily utilize two tests to screen male patients for prostate cancer. The idea is to diagnose the cancer early – before it has a chance to spread while treatment is likely to cure the cancer instead of waiting until the cancer progresses and spreads at which point there is at this time no known cure. The first is a physical examination of the prostate gland for any abnormalities that may be the effect of prostate cancer. The other test is the PSA blood test which measures the amount of prostate specific antigen in the bloodstream. A PSA greater than 4 ng/ml for example is normally thought to be high. There is variation based on such factors as age with younger men expected to have lower PSA levels. As prostate cancer increases the PSA level when prostate cancer progresses doctors generally advice a biopsy if the PSA test registers high.
When an issue other than prostate cancer triggers the PSA level to climb the heightened PSA is called a “false positive.” There are also potential complications correlated with biopsies, including excessive bleeding and infection. Because of these 2 issues a number of doctors advocate that male patients follow a strategy of “watchful waiting.” Under such a plan the doctor tracks the man’s elevated PSA during a time spanning of months or years. During this time a number of doctors recommend that the patient go on non cancer related treatments, for example, for infection, based on the theory that if the PSA is elevated due to something other than prostate cancer it is possible that the treatment could lower the PSA back to normal levels.
The danger with doing this is that the physician might wait too long before doing any additional tests to evaluate if the high PSA level is because of prostate cancer. As the PSA raises the probability increases that the rising levels are from prostate cancer, as does the likelihood that the cancer has metastasized. For men whose cancer is detected while it is still only within the gland, the likelihood is more than 90% that they will still be alive 5 years beyond diagnosis. The percentage is less for the more aggressive forms of prostate cancer. This percentage is referred to as the 5-year survival rate.
Treatment options for advanced prostate cancer may include hormone therapy, radiation therapy, orchiectomy , and possibly chemotherapy. Treatment will normally lead to a major decrease in the PSA levels for some time. Over time, though, treatment will no longer hold the cancer at bay. At this point the cancer will again commence spreading. This is typically associated with a new rise in the PSA level. At the point where treatment ceases to be effective, prostate cancer is fatal. As of when this article was written about 32,000 men per year are going to pass away in the U.S. from stage 4 prostate cancer.
What percentage of these 32,000 deaths will be due to a doctor counseling the manhis patient to stick to a plan of “watchful waiting” and then did nothing while the cancer spread? Perhaps we may never know how many of these men’s lives might have been saved had the physician advised the patient get a biopsy.
By taking a “watchful waiting” strategy and merely monitoring a man’s elevated PSA, a physician puts the patient in danger of not doing anything about the cancer until it gets to an advanced, possibly untreatable, stage. If this happens the doctor maight be liable under a medical malpractice claim.