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P R O S TAT E C A N - CER IS a commonly d ia g nosed ca ncer a mon g A mer ic a n men a nd rema i ns a l e a d i n g c a u s e of ca ncer-relat ed death. Historically, the diagnosis of prostate cancer occurred at a late stage and typically only upon presenting with symptoms such as bone pa in. In the late 1980s, the prostate specific antigen (PSA) test emerged as a blood test to screen for prostate cancer. However, the benef it of the PSA test remains controversial. T he debate su r rou nd i n g t he PS A test centers on whether the benefit of screening all men with the test outweighs the risk of unnecessary treatment. The theory by those who oppose universal PSA screening is that it leads to overtreatment by detecting small cancers that may never become deadly and in turn results in pos- sibly unnecessary cancer treatment. The purpose of this article is not to weigh in on this controversy but rather to highlight that the controversy exists and to explain how it may affect the defense of a lawsuit involving the failure to diagnose cancer. PSA DELIBERATIONS The American Cancer Society recom- mends that physicia ns g ive men the opportunity to make an informed decision as to whether to undergo prostate cancer screening using the PSA . In other words, a physicia n should inform their patient of the risks a nd benef its of undergoing the test. The physician should document t he fa ct t hat t h is conversat ion took place. If a patient elects screening for prost ate ca ncer usi n g t he PS A , it is impor ta nt for the physicia n to review the results a nd consider their mea ning in the context of the patient 's age, demo- g raphics a nd risk factors. Even if the ordering physicia n is not a proponent of PSA testing, it does not help to order the test if the results a re not going to be eva luated a nd considered. The need to consider the test result in light of the patient 's age and risk factors is even more important when the results a re abnorma l. Depending on the PSA level, a physicia n may choose f ur ther investigation with diagnostic tests such a s i ma g i ng, biopsy or shor t i nter va l repeat PSA testing. The physicia n may decide that a lthough elevated, the ele- vation is not sig nif ica nt enough g iven the patient 's specif ic demographics and risk factors to wa rra nt inter vention. DOCUMENTING MEDICAL JUDGMENT There is no question that an element of medical judgment is involved as the physi- cian interprets significantly elevated PSA levels and determines what, if anything, to do about them. Whatever the decision, it is important to incorporate the patient in the discussion of the results. It is equally important to document the interpreta- tion of the result and the treatment plan. A patient receiv ing a dia g nosis of prostate cancer may consider whether the diagnosis was timely. His next step may be to find a lawyer. The patient, now plaintiff, will argue that the defendant physician did not appropriately consider the sig nif ica nce of a n elevated PSA . Given the controversy surrounding test- ing and the significance of elevations in the PSA, reasonable decisions can often be defended as an exercise of medica l judgment. However, it is critical that the physician document the judgment and its basis in the medica l record. Without documentation of the thought process at t he time, i.e. why t he elevation in PSA level did not wa rra nt immediate inter vention or investigation, a good pla intif f 's law yer will pick apa r t the defense. More importantly, it becomes difficult to persuade a jury that this was, in fact, an exercise of medical judgment rat her t ha n a conven ient a f ter-t he- fact excuse. A well-documented chart detailing the thought process at the time ca n sometimes dissuade a pla intiff 's law yer from bringing the lawsuit in the first place. ■ Partner Daniel L. Freidlin is an attorney at Martin Clearwater & Bell LLP where he focuses his practice on the defense of medical malpractice matters. For more information, visit mcblaw.com. The Utility of Documenting PSA Test Results in Failure to Diagnose Prostate Cancer Litigation BY DANIEL L. FREIDLIN, ESQ. 2 6❱❱❱❱❱ L E G A L E A S E SPECIAL CLINICAL SECTION: MEN'S HEALTH