GPs never told man of cancer indicators

Two GPs have been ordered to apologise to a man who was not informed multiple tests taken across more than a year suggested he might have prostate cancer.

The man went to his doctor complaining of urinary problems in November 2015 and a specialist quickly confirmed he had prostate cancer — but the patient had not been told that the first signs of the cancer had been picked up by his doctors more than a year earlier.

In 2014 the man was seen by a locum GP at his medical centre for a digital rectal examination and a blood test for PSA because his brother had been diagnosed with diabetes and prostate cancer.

The PSA test results came back at 7.2 micrograms per litre. The laboratory said the normal range was up to 6.5 and about a third of cases between the upper limit and 10 resulted in cancer.

When the man’s usual doctor reviewed the results he decided it was probably a benign prostatic hyperplasia and said he would repeat the PSA test in six months.

The man said he was not made aware of the result.

Just over six months later, a second doctor ordered blood tests, including a PSA test.

In May 2015, the results showed PSA levels at 10.5. The laboratory noted levels over 10 micrograms per litre suggested cancer was more likely than a benign hyperplasia and suggested the test be repeated in several weeks.

The second doctor considered the results were borderline and was not aware of the Ministry of Health guideline that patients be informed and that men aged 71-75 be referred to a urologist. He documented a recall for another test in three months.

In August the man was recalled for another blood test but a PSA test was not mentioned and was not done.

In November he went to the doctor complaining of urinary problems. The first doctor performed a digital rectal examination and the doctor found the man’s prostate was slightly enlarged and nodular.

The doctor ordered more tests and referred the man to a urologist. The November PSA test came back showing a level of 15.3 micrograms per litre.

A biopsy showed the man probably had locally advanced or metastatic prostate cancer.

A bone scan showed no bone disease but an MRI showed the cancer had spread around his pelvis.

Health and Disability Commissioner Anthony Hill considered that the first GP failed to provide information a reasonable consumer, in that consumer’s circumstances, would expect to receive when he did not inform the man of the 2014 test result, its implications, and the management plan to retest his PSA level in six months.

Hill found the second GP did not provide services with reasonable care and skill when he failed to order further tests to rule out other causes for the elevated 2015 PSA test result, and by failing to document relevant clinical information, including the reasons for ordering a PSA test, his assessment of the PSA result, and his plan to conduct further PSA testing in three months.

Hill said the medical centre also owed a duty of care to the man when managing recalls for future blood tests and failed to provide services with reasonable care and skill.

He ordered both doctors and the clinic to provide the man with an apology and to undertake audits to ensure processes were followed.

Hill also recommended the Medical Council of New Zealand review the second doctor’s competence.