ring. Monitoring is frequently done with periodic measurement of PSA levels. At this point, reporting the condition to the AME may begin so that the pilot can obtain clearance to resume flying assuming there is no metastasis beyond the prostate. Controllers have to get clearance through the Regional Flight Surgeon.
Alternatives to Surgery
Several alternatives to surgical treatment exist. Microwave treatment of the prostate is a relatively new treatment option . A probe inserted into the penis can “cook” the cancer in the prostate. Because it is a new treatment, long term success and complications are not yet well documented. A similar investigational treatment is cryosurgery which freezes the prostate using a penile probe similar to the microwave therapy. Both types of treatment may not be covered by insurance companies since they are not yet widely accepted. Both are a viable treatment options allowed by the FAA.
Radiation Therapy – External Beam
Radiation to the prostate cancer is a third treatment option. Frequently radiation is recommended as an adjunct to surgery if the cancer has spread beyond the prostate. Two forms of radiation delivery exist. The first is External Beam radiation (EBR) . This uses radiation “guns” to shoot the prostate through the skin with doses spread over weeks to months. The FAA will not certify pilots to fly or controllers to work while they are undergoing EBR. The major complications are skin irritation and breakdown (painful sitting) and delayed impotence. Proton irradiation may decrease these complications. Proton beam therapy is a newer technology available in a limited number of treatment centers that may have fewer side effects than traditional radiation therapy. It is also acceptable by the FAA for treatment.
Radiation Therapy- Seed Implantation
The second form of radiation delivery, also known as brachytherapy, is radium seed implantation. These are “splinters” of a radioactive material that are inserted into the prostate similar to a biopsy technique. They deliver radiation to the prostate over extended periods of time. Again, impotence is a potential complication but skin breakdown is less common. The FAA has certified pilots to fly while the have Radium seed implants to treat an otherwise controlled cancer. Again since Apr 2013, AME’s can clear airmen to flying if cancer is confined to prostate. Controllers require specific clearance from the Regional Flight Surgeon.
High-Dose Rate Brachytherapy
A third form of radiation delivery is high-dose rate (HDR) brachytherapy. In this form of treatment, a highly radioactive Iridium-192 source is welded to a wire used inside of a catheter. The Iriduim source is advanced in half centimeter increments directly within the tumor. Because of the high dose, only a few minutes of exposure are required in 3-10 sessions for treatment. The wire is withdrawn at the end of each treatment, thus the individual has no permanent radiation source as with radium seed implants. Radiation damage to surrounding healthy tissues is minimized.
High-Intensity Focused Ultrasound
HIFU (or sometimes FUS for Focused UltraSound) is a highly precise medical procedure that applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation.
Chemotherapy used toxic medications to attempt to kill cancer cells. Chemotherapy is not very successful in prostate cancer and is not used as the only treatment for the condition. It may be used as an “adjunct” or additional therapy to surgery or radiation. Because it is not tolerated very well by those who are candidates for this treatment, the FAA generally does not waive pilots to fly or controllers to control when they are on this treatment. Other forms of medications are better tolerated in prostate cancer and potentially more effective. They are directed at manipulating hormone levels that may slow the progression of prostate cancer.
The final therapy for prostate cancer involves hormone therapy. Hormones that inhibit testosterone block a stimulus for prostate growth. They inc