Medical Negligence

My husband now very sadly passed in July 2014 having been diagnosed with Prostate cancer Aug 2013 which had metastasised to his bones This was discovered after a fall .

He had presented himself to his GP in February 2011 with excessive urination at night

 He was also given a rectal examination and was told he was “fine”

At that time, we now know his PSA was 5 , at 67 years ,we now know he should have been retested and he should have been referred to a urologist

On diagnosis on 19th July 2013 -10.2 24 July= 11.6 29th July -12.4

PSA

These are taken from expert witness account

 She says the PSA doubling time calculated between Feb 2011 and July 2013 is 22months I make that 29 months and surely that would make a difference to score

 An alkaline phosphatase measurement in Dec 2011 was 93 within the normal range which we have been told suggests there was no evidence of macroscopic bony mets at this stage .

By April 2013 it was raised to 2388 , this still didn’t alarm his doctor to examine him further .

 Expert Witness, an Oncologist and have been told in all probability my husband would have bone metastases back in 2011 and he would not have been suitable for surgery at that time and in all probability he would have lost his life at the same time

Myself and the family are convinced if my husband  had been referred to an oncologist in 2011 his life would have been been very different 

“We feel a window of opportunity was missed “

I have contacted varied cancer organisations and they feel it very unusal that a man would have metasis with PSA of 5

 I was wondering whether I should challenge this report

And whether anyone knows about the doubling calculator and what the results actually mean

17 Replies

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  • Hi  You mentioned "I have contacted varied cancer organisations and they feel it very unusal that a man would have metasis with PSA of 5"    Which cancer organizations are you referring to?

  • Prostate cancer UK 

  • Sorry for your loss.  I hope you can find closure.  It may be that my situation could be of help for you.  

    I am 58 years old and was diagnosed with " high risk" cancer that spread to a lymph node when my PSA was 4.7.  While low, it was a lot higher than the previous years value of 3.3.  That was enough to send me to an urologist.  When they found the advanced, stage 4 cancer they were surprised.  They first thought it was just an enlargement of the prostate.   During this time and over a period of a few weeks the PSA rapidly jumped from 4.7 to 11.3.  The doctors can not explain this rapid increase over a few weeks time. Because of how advanced the cancer was/is they believe that I probably had cancer for years, when my PSA was even lower.   From the pathology report I got after surgery (the surgeon at first did not want to operate but then changed his mind) it was a rare form of cancer (only 0.4 to 0.8%) that "hides out" in the prostate and lymth node ducts.  It is called Metastatic ductal adenocarcinoma.  If you google that phrase you will find articles dealing with low PSA levels.  Now I am awaiting to recover enough from the surgery to start radiation/hormonal/chemo.

    Again, I am very sorry for your loss.  I wish you well.

  • Thanks for that I should have said Mh died because he had a fall and broke his hip and wrist They couldnt operate on his hip and couldnt give him any more treatment for postate cancer I a

  • So sorry for your loss.  An Alk Phos that high seems incongruent with a PSA of 12.  Was he tested for neuroendocrine PCa?  That would explain the aggressiveness and the low PSA, perhaps.

  • Hi, In 2005 my husband had a PSA test during a regular blood panel- not for any complaints.  He was 55 at the time.  The doctor failed to let us know that a 5.1 could indicate a problem.  It was overlooked even though he saw her many times that next year because of an auto accident.  By January, 13 months later, he went back to her with rib pain.  Again, she just wrote it off.  She never referred him to a urologist or had the PSA repeated.  She never told us what a PSA, or 5.1 could mean.   Even, I, after just a little research realized that bone pain and out of range PSA and prostate cancer can be connected.  This should have never been overlooked.

    Yes, that rib pain meant the PCa had metastasized to his bone.   Now, at this point, removing the prostate wasn't an option.  So, we lost our choice of options from the initial PSA.  It is 9 years later and we are still in the ball game.  So, it isn't true, he would have died anyway.

    By the time, another doc had picked up on his rib pain, felt the bone, that was tender ordered a PSA and alk phos, his PSA was 234 alk phos over 400.

    Can you say more about what you mean by 'expert witness'... did you file a malpractice case?

    Recently we were told by a top radiologist that he doubted my husband had bone mets back 9 years ago- his reason, he wouldn't be alive today.

    Some of the stories are tough to hear.  We didn't know anything about prostate cancer.  My husband was 55, with no family history or friends with it.   We were blindsided by this.  Someone we trusted didn't know what she was doing.  He was strong and healthy, with no prior symptoms.

  • I was diagnosed with stage 4 prostate cancer and bone mets in 2011. My PSA was 3.5 and my annual checkup was fine. Both my urologist and oncologist advised me this is very unusual but does happen. When treatment started my PSA was 3 and is now undetectable. PSA is a tool but not the determination in every case of prostate cancer. Look into this before you start a lawsuit.     Best of luck to you 

  • Dear DFZ4835,

    Your story is giving me hope.  I am 58 years old and am in recovery from surgery.  Everything I read about low PSA cancer has me running scared. Your comments of where you were back in 2011 remind me of where I am now.   (I wrote an earlier post in this in this comment chain about my cancer.)  I have stage 4 that had spread to the lymph nodes (bone scan negative)  while my PSA was low (3.3 to 4.7, however once they found the cancer it jumped to 11).  I get very depressed with what I read on the Internet.  While not that much is apparently known about this rare cancer, what is known is not that positive.

    I am sorry that low PSA cancer hit you back in 2011, but your story gave me hope.  

    Thank you for giving me that!

  • I was diagnosed with cancer a month ago and my PSA was 2.7. The DRE test turned up a firmness/nodule. Wonder if a different doctor doing that DRE a year earlier missed it? PSA last year was 2.9, so it hadn't really budged.

  • Yes my husband started legal action

     It is being carried on since his death 

    The expert witness supposedly on his side, has said that on the grounds of probability he would have died at that time anyway

     It is that I don't know whether to challenge by getting another expert witness The Doctors admit they failed to follow the NICE guidelines

     I just want to get some sort of justice for him 

    I feel so cross with myself that I didnt know anything about PSAs I do now and accepted the GPS word as gospel 

  • If you feel strongly that you want justice for him, then seek justice.  I am a believer in not having regret, so things for me, decisions need to be well thought out, to the best that I can.

    Are you in this country? 

    The "probability" grounds may be the 5 year mark.  His death connected to the five year can be challenged.  Besides, these are things they throw out to deflect and wear down someone. 

    I would find a good lawyer who sees the justification in your case, if that is what you want to do.  

    I'm sorry you feel upset about not knowing anything about PSAs.  Many people don't.  It can be a silent disease for a long time.  This is why doctors need to pay attention to why they are in this work.  There are cases where a person has an under marker number- this isn't your husband's case, he had signs to merit further investigation.

    Something they already recognize.  So, the issue is he would be dead anyway.. that's beyond a ridiculous argument .... that argument can be challenged.

    I'm sorry you are going through this..

    genie 

  • Thanks I will

  • Thanks I will

  • I had bone matastases on my hip with  PSA of about 5-6. 

  • Here in the UK I had to insist on PSA tests and urologist last year if not my cancer could have spread outside the prostate a very small amount still may have, hence needing a short course in Radiotherapy, but with my previous Dr they just kept on desmissing it saying its just an infection at first then a year later saying its prostatitis it wasn't until I moved and changed Dr's and insisted they then decided to do something about it, I am so furious with my previous Dr's surgery, I wonder if there is anything I can say or do about the first Dr's i went to with this, I am sure I saw on the news a year or 2 ago the GP's where advised not to send people for expensive treatments or test if they had any doubts which sucks it is not there life they are playing with.

  • My husband started a case with solicitors No win no fee Its not actually the money that's important as it is probably very little after solicitors take their cut

    Its to make doctors suffer a little bit through there negligence

  • There are certainly strains of PCa that produce very little PSA. Small cell and neuroendocrine for sure, and that would have been evident from a a biopsy slide - although you do not report a biopsy. The incidence of this type of PCa in the US is around 1%-3% . In later stage disease the cells appear to morph to take on similar characteristics.

    I have also worked with men who have hormone sensitive disease and mets, and still produce very little PSA - as evidenced in this thread.

    If you are seeking a highly knowledgeable opinion from a genitourinary medical oncologist in the UK, consider Dr. Jonathan Waxman 1) imperial.ac.uk/people/j.waxman 2) theloc.com/consultants/prof... . Dr. Waxman is also the founder and President of PCUK ..... I would rely on his opinion far more than any lay person you spoke with in the PCUK offices.

    Onward & upwards, rd

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