Misdiagnosis: Malpractise?

Last Spring I had a DRE and my uro got a scared look on his face and said it was VERY abnormal. He did a biopsy a couple days later and confirmed PCa with Gleason score 9.

Backup in time 4 years earlier:
During a routine physical at age 49 my primary care doc did a DRE and believed something on the left side of the gland to be abnormal. He sent me to a urologist with a report of what he'd observed. The uro did a DRE and felt the same abnormality, but wrote it off as the seminal vesicles causing that feeling. My PSA was 1.67.

For the next three years I had two trips to my primary doc, but no DREs were done. Finally, after close to 4 years after that first DRE the doc did another DRE and said there is still something really wrong on the left side. So a trip back to the same uro finally led to the diagnosis. Upon consultation with the uro after receipt of the biopsy report, he said I had likely had PCa for at least 4 years.

I have read a lot of research on the benefits of catching PCa early, especially aggressive ones like mine. If left untreated too long, the cancer extends beyond the gland and into other surrounding tissues, including the lymph nodes, making curative surgery more difficult.

I had RRP early this summer. The pathology report grades it at pT3b. My first post op PSA was detectable, so now I have to have radiation before getting a chance to recover from ED. My surgeon (Fagin) tells me my ED and urinary status will be forever frozen about at the level it is at the time radiation begins.

I'm feeling if I had caught it 4 years ago, I could have improved my chance for curing this, and certainly would have avoided the radiation and HT, and could have recovered from ED.

Ive never contemplated suing anyone; not really my style. but now I'm feeling there may be some malpractice here. I would really appreciate hearing others thoughts. ALao, any tips on where to get answers on this?

Julios, This is an awful story. It is bad enough to have PCa, but to have your doctors miss it so blantantly is a crime. I honestly don't know if you have legal reecourse. You probably need to talk to a lawyer, but you have a serious medical condition. Don't let this legal issue side track you from dealing with your PCa, It's your top priority. Best of luck. BB

Julios,

I also had a bulge felt by my primary physician. Sent to URO, did biopsy, no PC, just HPINS.

Year and few months later went to another Uro for kidney stones. He did a DRE also, felt bulge, and did a biopsy. Gleason 9.

Surgery at Cleveland Clinic, clean margins, 15 month PSA <.01.

I say all this to say

Gleason 9 is a nasty, aggresive form of prostate cancer. It grows very quickly

You have no way of knowing when the HPINS became cancerous. I would say as a non-doctor, that 1.67 indicates you didn't have very much if any PC at the time

You can beat yourself up, you can sue the doctor and spend a lot of money on lawyers, and maybe you can get something, the odds are as a non-lawyer, you can't.

You can just accept that it is what it is, and concentrate your efforts on fighting the disease, not the doctor. You need all the mental strenght, all the physical stamina, and well being .

This disease is a son of a b. You will find guys with a Gleason 6 on here who had 5 % volume , and had to have SRT. You will find guys who have Gleason 8's or 9's who are still doing ok without the radiation. There is not a lot of rhyme or reason sometimes.

I certainly am not telling you what to do. I have had to go through a lot of thinking on this whole thing, and I have found that just accepting the hand I am dealt, and playing it, has given me a lot more peace than wishing for an ace.

I do wish you the best of luck. Hopefully the PSA will go down on the next test,and some of your worry will be for nothing. On the other hand, many men here have gone to the next step and done very well.

Julios,
I think you would have a difficult time proving malpractice. PC is sometimes difficult to detect (see my history). With a psa of less than two and given your age most doctors wouldn't recommend a biopsy. Also many doctors wouldn't recommend surgery for a G9 with a confirmed nodule.
JT

Julios,

I added a note on my first response - there is no one who should hold a 40-something man obligated to go off and search for a cancer that he should not have - unless there were family histories that were "writing on the wall".

But, I did not ask either. Is my doctor responsible? Only if there were tests I was obligated to take that would reveal PCa. There were not, he did not, and I did not ask.

As one who went from great health to supposedly near death's door in a month, I can only wish you the best, and encourage you to move ahead with deliberate attention.

 

Julios, was sorry to read of your story. I can definitely understand your anger over the situation but in all honesty do not see you winning a lawsuit which would be very expensive and lengthy.

My husband's PSA jumped up about 4 years before his diagnosis (he was 53 at the time). DREs performed by both his "regular" MD and the urologist revealed nothing, as did the biopsy. Four years later, when another big jump in PSA occurred during a routine annual physical, he was sent back to the urologist for another biopsy...this time, it came back positive in 2 out of 10 cores with a Gleason 3+3 and 3+4. He had surgery in March 2008, and his stage was upgraded from a T1c to a T3a (clean margins, etc. but EPE was noted in one small area). Is it likely that the cancer was there four years earlier...I would have to say "yes" but with a negative DRE and biopsy, there was nothing any doctor could do.

Yes, it's possible that if your cancer had been caught 4 years earlier it might have been "curable" but it's also very possible that your cancer was at a more advanced stage and would have required additional therapies. There's just no way to know and no way to prove it.

I do hope that you find some peace of mind and lots of hope from those here who are in the same situation, but I am sorry that you are facing it.

Hope that you focus on recovery and then later look at legal action, but adding a lawsuit to your plate now would not improve your health. Hope all goes well and keep us posted.

Michael

"Small, smooth, and firm". My husband would report with smugness the results of his annual DRE during his total physical. I know if anything other than that had been detected, his PCP would have had him go for further tests IF IT HAD BEEN A CHANGE. I have no idea what medical protocol is for obvious abnormality at original DRE. However, with prostate cancer at the top of the list for men's cancers, it seems as though it would have generated more alarm bells. An experienced lawyer would know.

At this point, however, stress is a major inhibitor to the healing and repair work your body needs. If malapractice suits are "not your style" then fighting against your nature is exactly that - a fight at a point in your life when you already have a huge one on your plate. I hope that you are able to focus all your energies on healing. I wish you all the best with your care.

"As men increase in age, their risk of developing prostate cancer increases exponentially. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 39 for ages 40 to 59, and 1 in 14 for ages 60 to 69. More than 65% of all prostate cancers are diagnosed in men over the age of 65."

Hey Julios,

Look at my stats. I was in a very similar situation. I had my 50 year physical at age 52 but my GP did not order a PSA ( it would have been my first) because he read a study that said men with no symptoms, no cancer in the family and normal DRE lead to over treatment and only saved one manin 1000.

Now look at my stats. My first PSA was 17.8 Biopsy up to 70% 7/12
I am incontinent and have ED. Would I be sitting here wearing pee pads if my GP had ordered the test during my "complete" physical? - I'll never know.
Jeff

Thank you all, for taking time to give me your impressions. It really helps. Jeff (worried guy), I really feel for you; thanks for sharing that. Our conditions are similar, except I have seminal vesicles and LN involvement in addition.

Actually, I have no anger at anyone. And I really do try to live my life living up to my responsibilities, and as a dad and as a staff supervisor, sometimes that includes ensuring others live up to theirs. From what I've read, performing a biopsy when such an abnormality is found is the current recommended practise. Back then, I knew nothing about PCa, PSA and biopsies, and had experienced my first DRE. I was too uninformed to even think about a biopsy or a second opinion. And I was never told to have it checked again. Im smart enough to eat right and excersize, and to go to the doc when something hurts. But back then I wasn't smart enough to ask for a biopsy. I was just glad the doc said I was ok. I'm expert in my job and do my job pretty well, and rely on others with the right expertise to do theirs. I may not have a good case, but if there is someone out there who isn't doing their job right, they may hurt someone else if no one says anything.

Carlos, thanks for the google search. I have done that as well, but need to do more.

I have my surgery behind me and my followup treatment determined, and will of course always keep that priority #1.

BTW, my surgeon, Dr Fagin, was not the one who misdiagnosed me. I highly recommend
Dr Fagin.

Julious-I think prevailing in a malpractice action would be difficult.

However, it does seem like the uro should have done a biopsy when he felt an abnormality during the DRE.

But biopsies don't always find the cancer.

Several members have had high PSA's and multiple biopsies before the cancer was found.

Also, you'd have to prove an earlier detection would have resulted in better results following treatment.

And prove you would have pursued treatment with a positive biopsy if you were a candidate for AS.

Too many uncertainties.