Legal Aspects of Men's Genitourinary Health

J. Henning; S. Waxman

Disclosures

Int J Impot Res. 2009;21(3):165–170 

In This Article

Prostate Diagnosis

Diseases of the prostate account for a large number of male patient visits to physician offices annually. Over 200 000 cases of prostate cancer are diagnosed annually in the United States. Failure to diagnose prostate cancer is the most common claim of omission error in urologic oncology.[4] Prostate specific antigen (PSA) testing has been available for over 20 years. Claims may arise for failure to perform PSA testing or for failure to act on abnormally elevated PSA values. Likewise, patients with delayed prostate cancer diagnoses will cite any earlier failures to perform a digital rectal exam or failures to act on abnormal exams.[11,12,13,14] PSA elevations secondary to prostatitis should normalize after treatment. Prostatitis refractory to treatment, or persistently elevated PSA values, should prompt a urologic referral.

Urologists often perform prostate biopsies on men with abnormal PSAs or digital rectal exams and the results often come back benign. These patients must be counseled that they should continue to undergo regular PSA checks and digital rectal exams as they could in fact still be diagnosed in the future with prostate cancer. Finally, when a prostate biopsy does show malignancy, it is up to the urologist to alert the patient of the results. Pathology results can be misplaced and not come to the attention of the physician. Never tell the patient to just assume no news is good news. One should always document the results and the treatment plan in the chart after calling a patient with any pathology report. It will be the critical piece of evidence should a claim be filed.

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