Prostate cancer

Medical history

A 62-year-old man complaining of severe chest pain over three to four days was referred by his GP to a consultant physician for private treatment. Initial investigations by the GP showed the patient was febrile and had an elevated ESR.

The patient told the consultant that the chest pain typically lasted for half an hour and that it was relieved by sitting up. On examination, the consultant found decreased breath sounds and tenderness in ribs eight, nine and ten on the right side.

The consultant wondered whether the patient had a pneumothorax or spinal problems, such as myeloma or bone secondaries. Rectal examination was normal, and the patient was admitted for further investigation, including chest and spinal x-rays, which revealed severe osteoporosis, spondylosis and several wedge fractures of the vertebral bodies.

Routine investigations showed that the patient had a normal alkaline phosphatase, protein electrophoresis, and no Bence-Jones protein in his urine. The pain was settled rapidly with physiotherapy only and the patient was discharged from hospital three days later.

A follow-up visit was arranged for a month later, but the patient failed to attend. He did, however, attend another appointment a month after that. At this visit the patient told the consultant that he had remained well until a week previously, when he had developed similar pain that spread from his back into both hips.

On examination, the patient showed normal neurological reflexes, but the consultant was also aware of the radiological report dated two months previously , which suggested that there was a visible abnormality of the fourth thoracic vertebra (T4). He therefore arranged for an acid phosphatase test to exclude prostatic cancer. The patient was referred for further physiotherapy and another appointment made for two months time.

A week later the consultant received the acid phosphatase report which was within normal limits; at the same time he heard from the physiotherapy department that the patient was now seeking an orthopaedic appointment via his GP.

The consultant made no further arrangements for the patient's care, as he felt this was now '...out of my hands...'

Six weeks later the consultant received a letter from the patient's GP informing him that the patient had become paraplegic while on holiday. This was subsequently shown to be due to spinal secondaries from a prostatic primary. Despite an emergency operation for decompression of the spine and two further operations, one a bilateral orchidectomy, the patient died two and a half years later.

The claim

It was alleged that the consultant had been negligent in failing to diagnose a patient's cancer when he had first been referred. As a result the patient had suffered pain for longer than would have been the case with an earlier diagnosis, and had developed avoidable paraplegia.

Expert opinion

The MDU obtained independent expert opinion from a consultant physician and a consultant radiologist/oncologist. They agreed that the patient's final prognosis had not been affected by the delay in diagnosis, as he already had widespread metastatic bone disease at the first referral. Nevertheless, the patient might not have suffered paraplegia if the diagnosis had been made earlier. The consultant had failed to appreciate the significance of the pain and the elevated ESR, and he had not followed up the radiological abnormality at T4.


It was decided to settle the case for £7,800 plus costs to reflect the period of paraplegia.

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