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Follow-up of abnormal PSA test result; timely open disclosure (15HDC00677)

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(15HDC00677, 19 May 2016)

General practitioner ~ Medical centre ~ Test results ~ PSA test ~ Prostate cancer ~ Open disclosure ~ Consent ~ Right 4(1), 6(1)

A 60-year-old man presented to his general practitioner (GP) with reduced energy and breathlessness. Amongst other investigations, the GP ordered a prostate-specific antigen (PSA) test because it was something he aimed to record every year or two and was approximately due. The GP received the PSA result, which was 8.3 µg/L, above the normal range of between 0.0-4.5 µg/L. The GP filed the elevated PSA result as "normal", and did not discuss the result with the man at his next consultation or take any further follow-up action.

Approximately two years later, the man presented to the GP with urinary complaints. The GP ordered a PSA test which came back as 66 µg/L, significantly above the normal range. During or soon after this consultation, the GP noticed the earlier elevated PSA result.

The GP informed the man of the recent PSA result, but did not disclose the earlier missed PSA result at that time. The GP told HDC that he did not want upset the man further before the man's upcoming overseas holiday. The GP made a referral to a urologist who confirmed that the man had a prostate tumour. Subsequently, it was confirmed that the man had aggressive prostate cancer that had spread to the lymph nodes in his pelvis.

The GP informed the man of the missed PSA result after the man returned from his trip, approximately two months after discovering the missed result.

By failing to recognise and take appropriate action on the abnormal earlier PSA result, the GP did not provide services to the man with reasonable care and skill, and so breached Right 4(1). The GP also breached Right 6(1) by failing to inform the man promptly about the missed PSA test result.

Other comment was made about the prospective consent the GP obtained for ongoing prostate screening before ordering the earlier PSA test. 

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