Internal Medicine Standard of Care: Elevated PSA Follow-Up

Representative facts: A 67-year-old man had a PSA level of 7.1 ng/mL ordered by his primary care physician. A repeat PSA two months later remained elevated at 6.8 ng/mL. Although the patient returned for multiple primary care visits over the next year, no further PSA testing, urology referral, or documented follow-up plan was completed. Approximately 16 months after the last PSA result, the patient presented to the emergency department with back pain and was found to have metastatic prostate cancer.

Issues for expert review:

·       Did the primary care physician deviate from the standard of care by failing to repeat the PSA, document follow-up, or refer the patient to a specialist?

·       Would timely follow-up or referral have altered the outcome?