d 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 monitoring. 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 