Failure to Diagnose & Delay in Treatment of Prostate Cancer

Evaluate breaches in the standard of care when evaluating Failure to Diagnose & Delay in Treatment of Prostate Cancer

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following risk factors did the patient present? (Choose all that apply)
    Over 50 years of age
    Over 40 years of age associated with risk factors of prostate cancer
    African American heritage
    Family History
    No relevant risk factors
    None elicited/documented
    Answer unknown
    Why is this important?
    Risk factors are useful for identifying patients at increased risk for a disease or for a particular outcome that results from a disease process.
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  • Did the clinican recommend that the patient be screened for prostrate cancer? Why is this important?
    Answer this question
    Screening for prostate cancer is controversial. As such, there are differing recommendations on prostate cancer screening from many specialty groups.
    (2009) 36 EPCCOP 3 603-621

  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Prostate cancer may be asymptomatic until it has progressed to the advanced stages. Bone pain may be the first symptom, as prostate cancer often spreads to the bones early. The pain is usually localized, constant, and severe, and it may be worse with movement.
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  • Was a detailed medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.
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  • What was the result of the patient's digital rectal examination? Why is this important?
    Answer this question
    The digital rectal examination (DRE) may reveal an area of increased firmness, loss of the normal gland features, or an irregularly enlarged prostate.
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  • To which of the following specialists was the patient referred? (Choose all that apply) Why is this important?
    Answer this question
    The patient needs to be referred to a urologist for full discussion of treatment options and prognosis, even if the patient declines diagnosis and treatment.
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  • Was a prostate-specific antigen (PSA) level screening test performed? Why is this important?
    Answer this question
    Screening for prostate cancer is controversial. As such, there are differing recommendations on prostate cancer screening from specialty groups.
    (2009) 36 EPCCOP 3 603-621

  • What was the result of the patient’s prostate-specific antigen (PSA) level? Why is this important?
    Answer this question
    PSA (prostate specific antigen) is currently the best available tumor marker for malignancy.
    (1997) 81 EMEDCN 3 801-822

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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  • Were serial prostate-specific antigen (PSA) tests performed? Why is this important?
    Answer this question
    Another method of using PSA (prostate specific antigen) to identify patients with prostate cancer is PSA-V or the rate of change in serum PSA over time. Also known as PSA slope, PSA-V requires at least three separate measurements using the same assay at least 6 months apart to be clinically useful.
    (1997) 81 EMEDCN 3 801-822

  • Was a percutaneous transrectal guided needle biopsy performed on the patient to confirm prostrate cancer? Why is this important?
    Answer this question
    Presently, most physicians use the 4 ng per mL PSA (prostate specific antigen) threshold for recommending a prostate biopsy.
    (2004)88 EMEDCN 2 245-265

  • Were the serial Prostrate-Specific Antigen (PSA) evaluations indicative of prostate cancer? Why is this important?
    Answer this question
    PSA (prostate specific antigen) levels are monitored over close time interval to check for any abnormal changes suggestive of prostate cancer. This is usually carried out in patients with borderline elevation of PSA or high PSA levels to rule out other conditions.
    (1997) 81 EMEDCN 3 801-822

  • Was the biopsy result positive for prostate cancer? Why is this important?
    Answer this question
    Biopsy of the prostate confirms the diagnosis and is the only way in which to make a definitive diagnosis of prostate cancer.
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  • Were serial Prostrate-Specific Antigen (PSA) tests recommended? Why is this important?
    Answer this question
    Another method of using PSA to identify patients with prostate cancer is PSA-V or the rate of change in serum PSA over time. Also known as PSA slope, PSA-V requires at least three separate measurements using the same assay at least 6 months apart to be clinically useful.
    (1997) 81 EMEDCN 3 801-822

  • Was staging for prostate cancer performed? Why is this important?
    Answer this question
    Prognosis varies with tumor stage and spread.
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  • Which of the following staging criteria was assigned to the tumor? Why is this important?
    Answer this question
    Two main clinical classification systems are used: the American Joint Committee on Cancer Tumor, Node, Metastasis (TNM) staging system and the Whitmore-Jewett staging system; the TNM staging system is more commonly used today.
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  • Was a staging work-up performed according to life expectancy? Why is this important?
    Answer this question
    The National Comprehensive Cancer Network (NCCN)guidelines for the management of clinically localized prostate cancer reflect the needed consideration of both life expectancy and the risk profile of the individual patient's cancer in making management decisions.
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  • Which of the following investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    A bone scan is used to evaluate the presence and degree of bony metastasis but is unnecessary in patients with clinically localized prostate cancer and a PSA level less than 10 ng/mL.
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  • What was the stage of prostrate cancer? Why is this important?
    Answer this question
    The stage (extent) of a cancer is one of the most important factors in choosing treatment options. The stage is based on the prostate biopsy results (including the Gleason score), the PSA level, and any other exams or tests that were done to find out how far the cancer has spread.
    Click here for additional information at Cancer.org