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Prostate cancer is a common type of cancer affecting male patients. Most prostate cancers are slow-growing; symptoms and signs include difficulty urinating or impaired sexual ability. Heredity and diet are implicated as possible factors in prostate cancer. It can be treated with hormone therapy and chemotherapy.

One of AME’s prostate cancer expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below. Prostate Cancer- delay in diagnosis, failed follow-up strategy

Attorneys are often consulted by patients who feel that they have not been properly followed after cancer had been treated and that a recurrence could have been diagnosed earlier but was missed. Different cancers have different follow-up recommendations. For prostate cancer,

PSA is the mainstay of the follow-up strategy.

One consequence of the routine adoption of PSA monitoring after treatment of early stage prostate cancer is the identification of men with a PSA-only recurrence. In this situation, increases in serum PSA over the pretreatment baseline are often not accompanied by signs or symptoms of progressive disease. When PSA rises, the physician is often faced with a quandary. The longer one waits to perform an imaging study, the greater the chance that a recurrence can be confirmed and treatment started. On the other hand, imaging too early in the course of PSA rising, might result in a negative study, frustrated patient, avoidable expense and the need to repeat imaging at a future time. If the rise in the PSA is slow and occurs after a prolonged period, the site of relapse is generally at the site of the original tumor. Since a significant number of these men are relatively young and otherwise healthy and can still be cured, intense interest has been focused upon their treatment, with particular attention to survival, and the impact of therapy on quality of life.

Treatment options for men with a PSA-only recurrence after radical prostatectomy include external beam radiation therapy (RT) to the prostatic bed with or without treatment of the pelvic lymph nodes (salvage RT), androgen deprivation therapy (ADT), a combination of salvage RT plus ADT, or observation. Most of the available data regarding these approaches has come from observational series. Long-term results of randomized clinical trials will be required to define the optimal approach.

After prostatectomy, PSA should be 0.0 or close to zero. Rising PSA suggests recurrence even if the absolute PSA values is low. When this fact is not appreciated, a recurrence can be missed because the PSA, although higher, is still within the “normal” range. There is some controversy on whether any PSA rise warrants re-treatment or whether the PSA Velocity (rate of PSA rise over time) should be used to predict when to intervene.

Wiegel T, Lohm G, Bottke D, et al. Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome–results of a retrospective study. Int J Radiat Oncol Biol Phys 2009; 73:1009.

Trock BJ, Han M, Freedland SJ, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 2008; 299:2760.

Boorjian SA, Karnes RJ, Crispen PL, et al. Radiation therapy after radical prostatectomy: impact on metastasis and survival. J Urol 2009; 182:2708.

Andrew J. Stephenson, Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy , JAMA. 2004;291:1325-1332

Biography

The Hematologist/Oncologist who wrote this article had been Associate Professor of Medicine while a full-time attending at the University Hospital of a Medical School until 2009. Prior to 2004 had been an Associate Clinical Professor of Medicine. He is currently in private practice. He is first author of over thirty academic articles, chapters and several books. Over the past two decades he held the positions of Interim Chief of Hematology and Oncology, Director of the Cancer Center, Chief of Hematology and Oncology and Chief of Service and concurrently Director of the Cancer Center Network of the Health and Hospitals Corporation and Co-Director of Oncology at a University Hospital and Medical Center. He developed and ran two clinical research programs as well as a community advocacy group, a consulting group, and a non-profit educational institution. In addition to Internal Medicine and Oncology. He is Board Certified in Quality Assurance and Utilization Review and holds an MBA. He was listed several times as the best in his specialty by the Castle Connolly Guide to America’s Top Doctors.

Prosthodontics is a dental specialty. Prosthodontists replace and restore teeth so that they can optimize the appearance and function of the patient’s mouth. They may replace missing or deformed teeth or remove wisdom teeth.

A psychiatric disability, or mental disorder, is any condition that impairs the patient’s cognitive functioning and/or behavior. Unfortunately, because the patient’s thinking and actions are abnormal, he or she will likely have trouble living in normal society. Treatment courses range from medication to therapy.

A psychotropic pharmaceutical, or psychoactive drug, is a chemical that acts upon the central nervous system (the brain and spinal cord) to alter the patient’s mood, emotional stability, consciousness, behavior, and thinking. Such drugs are used to treat a range of mental disorders.

Pulmonary medicine, or pulmonology, is a medical speciality that focuses on treating lung and respiratory diseases. It can also be called chest or respiratory medicine. A common disease that pulmonologists are concerned with is tuberculosis.

One of AME’s pulmonary expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below. Deep Vein Thrombosis And Pulmonary Embolism Medical Malpractice Cases

Deep vein thrombosis (DVT) commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis. Occasionally the veins of the arm are affected (if spontaneous, this is known as Paget-Schrötter disease). A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the superficial veins may be engorged.

The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). DVT is a medical emergency; present in the lower extremity there is 3% chance of a PE killing the patient.

Blood clots form in leg veins, break off and travel through the larger veins into the inferior vena cava, through the right atrium (blood receiving chamber of the heart), through the tricuspid valve into the right ventricle where it pumped under force through the pulmonic valve into the pulmonary (lung) artery. There it lodges like a cork blocking unoxygenated blood to that segment of the lung. Often small clots break off from the leg veins over time and then a very large clot which can block the heart/lung circuit causing death.

Post-operatively did the patient have anti-embolism elastic stockings ordered by the Surgeon and put on by the nurse? Were they used for every bed bound patient? Lying in bed causes blood to stagnate in the leg veins. Were the nurses encouraging the patient to exercise their legs in bed, particularly their feet /ankles up and down every hour? This motion caused by their leg muscle contractions, forces blood to move faster through their veins and reduces the risk of clotting.

The elastic bandages compress the superficial veins forcing more blood to flow faster through the deep veins, where the greater risk of clotting occurs.

Also, in high-risk immobile patients the use of an injectable blood thinner (anticoagulant), heparin at 5,000 units, twice a day, also reduces that risk without significantly increasing the risk of bleeding.

With chest pain occurring in such a high-risk patient, the diagnosis of a pulmonary embolism must be considered and ruled out. Was a Spiral CT ordered, Blood gases, ankle pumps, regular blood tests to determine therapeutic status of anti-coagulation done, was there a consult with a pulmonary specialist?

With the diagnosis made, therapeutic doses of heparin (anticoagulant drug) are given to decrease the clotting ability of the blood as measured by the partial thromboplastin time (PTT) test. This drug is usually continued for 5-10 days after the symptoms are gone, and then the patient is converted to the oral anticoagulant Coumadin (warfarin) for 6 months to one year.