Expert in Urologic Oncology Delineates PSA Testing Standards

A patient’s death from prostate cancer caused charges of negligence to be raised against his general physician, who allegedly never fully discussed the benefits and drawbacks of PSA testing during his treatment. In a medical case spanning four years, the patient’s PSA levels had dropped from a dangerously high 12.8 to a healthy 3.0, with his initial prostate exam concluding that he was healthy and at no risk of cancer. A second exam some time later indicated an enlarged prostate, which was treated with cooled thermotherapy and followed by more PSA testing. Over the next four years, the patient’s urinary system was monitored and began to show signs of neck and shoulder pain. An MRI scan on his neck showed multiple abnormalities in the cervical thoracic spine, and he was diagnosed seven months later with widespread metastatic cancer originating from the prostate. His health eventually declined, and he died the next year from cancer. It was alleged that his doctor had been negligent in the PSA screening process, and a urologist was needed to review records and opine on if screening may have created a better outcome for the patient.

Question(s) For Expert Witness

1. Please briefly explain your general experience with and knowledge of PSA testing.

Expert Witness Response E-008939

As an academic urologic oncologist, I am very experienced with PSA testing on patients and the controversies surrounding PSA testing. PSA testing should be considered in patients who are at higher risk and in patients age 55-69. Testing should be performed annually or every two years. Benefits include 20% reduction in disease specific death, other benefits may include other outcomes. Drawbacks include low specificity findings may lead to biopsy or other procedures which have risk.