Delay in diagnosis of prostate cancer

We investigated the care received in relation to monitoring an enlarged prostate. The Trust had failed to consider the need to check our client’s PSA levels, after noting his ‘markedly enlarged prostate’.

Delay in diagnosis of prostate cancer

According to Cancer Research UK, prostate cancer is the most common cancer in males in the UK and it does not discriminate by age or ethnicity.

The most common symptoms of prostate cancer are:

• Passing urine more often
• Getting up during the night to empty your bladder (nocturia)
• Difficulty passing urine (including a weaker flow – not emptying the bladder completely) and straining when starting to empty your bladder.
• Blood in the urine or semen is perhaps the most alarming symptom which should be investigated urgently.

Danielle Pritchett, an associate solicitor specialising in medical negligence claims said:

“In this sad case, my client was in his mid 50s when he was eventually diagnosed and the thought that his enlarged prostate could have been indicative of cancer did not cross his mind.

She added: “This indiscriminate disease often affects men over 65 but it is very important that any man, of any age, who has concerns or suffers from any of the symptoms listed above, gets himself examined and referred for further tests without delay”.

Our client’s story

Our client, had been seen at Northern General Hospital in early 2016 for urinary retention. He was fitted with a catheter and referred for urology follow up. During April 2016, a urologist at the same hospital examined our client and noted that the earlier episode of urinary retention had occurred after drinking a couple of pints of alcohol. Our client described his urine flow as slow and said that it had been like that since an accident the year before. He also advised the medical staff that he had a sensation of incomplete bladder emptying.

Examination showed ‘quite a markedly enlarged prostate at around 50g, nontender and not overtly suspicious’, so our client was started on Tamsulosin, a drug to help reduce the symptoms of his enlarged prostate.

The urologist then made follow up arrangements, but these were dependent on the outcome of our client’s trial without a urinary catheter. Unfortunately, the urologist failed to monitor our client’s Prostate-Specific Antigen (PSA) level by arranging a simple blood test. PSA is a protein produced by normal prostate cells, however, it can be produced in much higher levels if cancerous prostate cells are present and therefore a high PSA level can be indicative of prostate cancer.

During the summer of that year, our client attended Northern Lincolnshire and Goole NHS Foundation Trust with a problem of urine retention. He attended his GP and again requested a referral to a urologist. Our client was advised by his GP to continue with the advice of the previous urologist, Mr Patterson, and try another drug to help with the symptoms of an enlarged prostate. Once again there was a failure to check our clients PSA levels.

In January 2017 our client was coughing up blood (haemoptysis). He had a PET scan and bloods were taken. The results delivered two months later showed an elevated PSA of 37.8 ng/ml (a normal PSA level should be 4.0ng/ml). Mr X had biopsies of his prostate in early spring 2017, all of which confirmed prostate cancer which had grown and spread into the outermost layers of the colon or rectum.

The claim

The client instructed a medical negligence specialist in our team to investigate the care he had received. Danielle Pritchett handled the case, sending a detailed letter of claim was to the Trust on the basis that it had failed to consider the need to check our client’s PSA levels, after noting his ‘markedly enlarged prostate’. The Trust was further negligent by failing to ask the GP to arrange for a PSA test should a further episode of urinary retention occur.

Expert evidence obtained by Fletchers showed that, on a balance of probabilities, If PSA testing had been undertaken sooner, the levels would have been raised and our client would have been sent for a biopsy sooner. This would have led to an earlier diagnosis of prostate cancer and a better outcome. In their letter of response, the Trust admitted liability for the allegations raised, and provided an apology to our client. After receiving the admission of fault from the Trust, our client our client added:

“Thank you, Danielle. I cried after I spoke to you. At last, someone admits that they were wrong. That’s down to you and I will always be grateful”.