Prostate cancer is a very common condition that increases in frequency as men grow older. Although the disease may be very serious and lead to death, most cases are curable if detected early and treated. Many pilots and controllers fear losing their FAA medical certification if they are diagnosed with prostate cancer and put off regular examinations to avoid the requirement to report this to the FAA. We encourage regular evaluations with your physician for this treatable disease.
Approximately 200,000 cases of prostate cancer are diagnosed in American men annually. Nearly 32,000 men will die of this disease each year. However, if detected early, the cure rate for prostate cancer is almost 100%.
The primary risk factor for prostate cancer is increasing age, particularly over age 50, with half of all cancers occurring after age 65. African-American men have twice the rate of prostate cancer as do white American men.
Two primary tests screen for prostate cancer: the Digital rectal Exam (DRE) or “finger wave” and the Prostate Specific Antigen (PSA) blood test. Neither is adequate alone; the tests are complementary. Most men should be screened by age 50, or sooner if they have a history of prostate cancer in the family.
If a nodule (lump) is detected on DRE or if PSA levels are elevated and/or rising on repeat testing, your physician may recommend a transrectal ultrasound (TRUS) to further define any irregularities that may be prostate cancer.
If a nodule is confirmed or there are other indications of prostate abnormalities, the next step is a biopsy of the prostate. The biopsy is obtained by using a needle inserted in the prostate gland to remove a sample of tissue. This sample is studied by a pathologist who determines if the prostate is normal or if it contains cancer cells. If cancer is found, it is “classified” according to how aggressive it appears using the Gleason scale. Most men describe the biopsy as uncomfortable but not seriously painful.
Other Causes of PSA Elevation
Another common cause of mildly elevated PSA tests and enlargement of the prostate is Benign Prostatic Hypertrophy (BPH). This is a universal condition in older men who may notice a less forceful urine stream, prolonged urination and waking up at night to urinate.
There is some controversy over the relative risks and benefits of screening low risk men for prostate cancer with PSA alone.
Cancer Treatment Options
If prostate cancer is diagnosed, your physician will discuss treatment options with you. One option is watchful waiting with frequent DRE and PSA testing. In many cases, pilots may fly after appropriate reporting to the FAA while under careful observation. Controllers will require specific clearance from the Regional Flight Surgeon. For airmen, in Apr 2013 the FAA delegated authority to the local Aviation Medical Examiner to clear pilots to fly if their prostate cancer is confined to the prostate.
Surgical Options and Staging
Many men with prostate cancer elect to have the prostate removed. The procedure is called prostatectomy. It can be done by several techniques. The major complication from prostatectomy is the possibility of impotence or impaired sexual functioning. A new technique called the “nerve sparing prostatectomy” may decrease this complication rate. At the time of surgery, the surgeon and the pathologist will determine if the cancer is confined to the prostate or has spread to surrounding areas. This process is called “staging”. If the cancer has grown beyond the prostate, but not to isolated and distant areas, this is called local extension. If the prostate cancer has spread to distant areas, the term is “metastatic” cancer. Frequently, if a surgeon suspects distant spread, they may recommend additional blood tests or diagnostics scans, (CT, MRI, radionuclide studies). The results of these tests determine treatment recommendations.
In most cases, the cancer is confined to the prostate and surgery cures the condition. After a recovery period of several weeks, the individual may return to full activity with continued periodic monito