A New York man in his 50s was evaluated by his urologist in 2009, and his PSA level was elevated from previous results. A course of antibiotics was prescribed and a repeat PSA level was decreased to within his typical range.
Four months later, he was seen by his internist for an examination and blood work was requested that included a prostate specific acid phosphatase (PSAP) level. The test results were reported as normal, and the internist forwarded the results to the patient’s urologist. A month later, the urologist questioned the PSAP results and ordered a PSA test, which was slightly elevated at 3.43 ng/mL.
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Six months later, the PSA was repeated and was found to have increased to 4.09 ng/mL. The urologist then biopsied the patient’s prostate, and the pathology showed cancer. The patient underwent a prostatectomy, and the pathology report revealed a spread of the cancer beyond the capsule of the prostate.
The man sued the physicians and claimed that even though no metastasis from the prostate has been observed, the extracapsular extension increases the likelihood of cancer recurrence. He alleged the physicians failed to properly monitor his condition and allowed the cancer to extend. He claimed the internist should have ordered a PSA instead of the PSAP, which he said would have avoided confusion over the results and would have led to earlier diagnosis of cancer and prevention of the extension. He also claimed the urologist should have tested his PSA earlier.