A man in his 60s, whose elevated prostate test result was overlooked by his GP for two years, has terminal cancer, according to a report issued today.
An investigation by the Health and Disability Commissioner found the GP breached the code of patients' rights by failing to recognise the elevated test result and take appropriate follow-up action.
The man, unnamed in commissioner Anthony Hill's report, was 60 in 2012 when his GP, also unnamed, received a PSA (prostate specific antigen) blood-test result that was above the normal level. The result, which arrived on March 9, 2012 was 8.3 micrograms per litre; the normal range would have been zero to 4.5 micrograms per litre.
The GP, "Dr A", had ordered the prostate test among other blood tests when the man, "Mr B", had presented to him four days earlier with reduced energy and breathlessness.
"Dr A filed the elevated PSA result as 'normal'," Hill said, "and did not discuss the result with Mr B at his next consultation on 10 March 2012 or take any further follow-up action. On 28 July, 2014, Mr B presented to Dr A with urinary complaints, and Dr A ordered a PSA test, which came back as 66 micrograms/L, which is significantly above the normal range.
"It was during or soon after the 28 July 2014 consultation that Dr A noticed the earlier elevated 2012 PSA result."
The GP told the man of the new PSA result but did not disclose the earlier, missed PSA result saying later this was because he wanted to avoid causing the man further upset before he left on an overseas trip.
He told the man when he returned, around two months after he had discovered it. A urologist confirmed that he had a prostate tumour. Later, an oncologist found that he had aggressive prostate cancer that had spread to lymph nodes in his pelvis. The prognosis was of a terminal condition.
The man told the investigation that the GP should have been more diligent when checking his results and the GP should have informed him of the missed PSA result as soon as it was discovered.
The time it took to inform him was an error of judgment.
"Mr B also said that he has had great difficulty in accepting that he has terminal cancer, and that his ongoing treatment has had a significant impact on him.
Hill said the GP should have told his patient of the missed abnormal result "in a timely manner and certainly before he left for his trip".
The GP told the inquiry: "I have no hesitation in apologising for the error I made in my care of [Mr B]. I deeply regret overlooking the PSA result in 2012. ... I can assure the HDC that I will do my utmost best to ensure the same errors in this case will not occur again the future."
Hill said " ... doctors owe patients a duty of care when handling results, including advising patients of, and following up on, their results."