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 The wire is withdrawn at the end of each treatment, thus the individual has no permanent radiation source as with radium seed implants.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 include Casodex (bicalutamide) and Eulexin (flutamide). Other hormones inhibit the release of hormones that stimulate testosterone. They include Lupron (leuprolide) and Zoladex (goseralen). Usually hormones from each category are given simultaneously. The major side effects include hot flashes and sweating. The FAA will recertify airmen and controllers taking hormones for this condition.
Prostate cancer is the most common cancer in adult men, but is not the most common cause of cancer deaths. Some cases are relatively slow growing and pose little immediate risk to an individual. These cases may not require immediate treatment, but can be followed with careful monitoring. This approach, termed “ Watchful Waiting”, is sometimes recommended in early stages of low grade, slow growing prostate cancer and in older gentlemen. This may reduce the risk of impaired sexual function and loss of bladder control some men experience with other treatments for prostate cancer. Monitoring of the PSA level on a frequent basis is critical for this approach. A rise in the PSA may signal a transition to a more aggressive type of cancer or spread of the cancer.
Again since Apr 2013, AME’s can clear airmen to flying if cancer is confined to prostate. There is some confusion whether or not watchful waiting is included in this policy since it isn’t specially addressed in the Guide to Aviation Medical Examiners. However, the Manager of Aeromedical Certification in Oklahoma City has confirmed that the intent is to allow AMEs to clear watchful waiting as long as cancer is confined to the prostate. Controllers require specific clearance from the Regional Flight Surgeon.
FAA certification after diagnosis of prostate cancer generally requires the operative report and hospital discharge summary (if any), pathology and laboratory reports, the results of any scans or tests for metastatic disease and a statement from the treating physician that the pilot may return to full activity. The physician statement should mention what follow-up evaluations are