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December 14, 1957


Author Affiliations

Portland, Ore.

From the Department of Surgery (Urology) of the University of Oregon Medical School and the Veterans Administration Hospital.

JAMA. 1957;165(15):1905-1907. doi:10.1001/jama.1957.02980330007002

The causes of delay in getting a patient to definitive surgery have been studied in 112 men undergoing radical prostatectomy for prostatic carcinoma. The interval was measured from the time when the diagnosis could have been made by the examining physician to the actual date of surgery. The period preceding the examination is not measurable because early prostatic cancer is asymptomatic. The delay following examination was considered excessive in 29 cases, and the major responsibility was considered to be the physician's in 22 instances and the patient's in 7. The most common cause of delay by the physician was failure to recognize cancer in the presence of prostatitis or to distinguish between the two conditions. In four instances delays up to two years occurred because the finding of a prostatic nodule was not followed by a more thorough study. Misleading results of needle biopsies and irrational attempts at palliation with estrogens were also occasionally responsible. The authors believe that every prostatic nodule should be subject to open biopsy, with all preparations made for immediate radical prostatectomy should the frozen section be reported positive. The family physician should combat the patient's fear and lack of understanding. He can thus minimize delays and increase the number of prostatectomies done early enough to effect a cure.