Raised PSA

The patient was a 54-year old man who was found to have an elevated PSA (5.6) and referred for a cystoscopy and prostatic biopsy, which was negative. Four years later, he saw his GP who requested a further PSA which was still raised (5.6). Nine months later he saw another GP reporting painless haematuria for three days. An MSU test and urinary cytology were both normal. Three months later the patient saw an MDU GP who requested a PSA which had now risen to 13.8. It appeared that no action was taken on the result.

Seven months after this test the patient saw another MDU GP about an entirely different complaint. The doctor spotted in the patient's notes that the last PSA had not been investigated further. He immediately ordered a repeat test, which was reported at 9.5, and referred the patient to a urologist on a non-urgent basis. Prostatic biopsy was positive with a Gleason Score of 3+3. The patient underwent a radical prostatectomy which, somewhat surprisingly, showed only two very small loci of malignancy.

The patient brought a claim alleging negligent failure to inform him of the PSA result of 13.8. It was further alleged that it was negligent to have waited a further seven months and only to have repeated the PSA test when he returned to the surgery.

The doctor spotted in the patient's notes that the last PSA had not been investigated further.

The MDU obtained a report from an independent GP expert who considered that the first GP should have referred the patient for further investigation when his PSA was found still to be high after four years. He was also critical of the failure to refer or to arrange a further PSA test when the patient presented with painless haematuria. The expert was highly critical of the failure to refer the patient when the PSA of 13.8 was received and he stated that he considered that this resulted from a systems failure within the practice. He also considered that the referral which eventually took place should have been made under the two-week rule procedure.

The MDU obtained a report from an independent urology expert. The expert considered that it is likely that the tumour would have been at the same stage when the PSA was 13.8 as it was at referral to the consultant urologist, and the same treatment would have been offered. The expert commented that in view of the very small size of the tumour, it is highly likely that the patient had been cured by the radical prostatectomy. This view was accepted by the claimant who then only sought compensation for his distress in discovering the delay in diagnosis. The claim was settled for £4,500.

Dr Frances Szekely
Senior medical claims handler

This page was correct at publication on 04/12/2013. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.


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I believe as well as many other radiologist might believe that transrectal biopsy is a matter of hitting the prostate by a needle 12 times or more blindly and then just let the pathologist say is it cancer or not...The accuracy is not more than flipping a coin and negative results can not exclude real cancer.This malpractice is a fact. The question :Is it the time that MRI will trash such useless biopsies and focus on targeted biopsy under MRI guidance and combined MRI and ultrasound ..

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