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February 3, 2014
By Warren Silberman
Schuyler Sky King, a law enforcement officer from Grover, Ariz., was having many problems with urination, so he was seeing a urologist pretty regularly. He was a law enforcement pilot flying a 1960 Cessna 310D off his ranch, The Flying Crown, and required a second class medical certificate for his job. He had done much reading on his symptoms of prostate enlargement and knew that the FAA accepted the use of "alternative therapy," so he regularly took saw palmetto, which did relieve some of his urinary symptoms. He saw his urologist every six months and was performing regular PSA levels.
PSA, or prostate specific antigen, is a protein produced by the prostate gland. The PSA test measures the level of PSA in the blood. The higher a man's PSA level is, the more likely it is that he has prostate cancer. There are other reasons that man can have an elevated PSA level, and some men who have prostate cancer do not have an elevated level. Prostatitis or inflammation of the prostate gland and a urinary tract infection can cause the PSA level to rise. The PSA test is also a means that the urologist uses to follow a man who has had prostate cancer. If the cancer recurs after initial treatment, the level will rise. Most doctors consider a PSA level of 4.0 ng/ml and lower as normal. A level above 4.0 would usually result in a prostate biopsy. There are physicians who treat this condition who will perform the biopsies if there is a significant rise within the normal range in the PSA level from one test to the next.
King had attended one of the last AOPA Aviation Summits, in Palm Springs, Calif. He had joined the Pilot Protection Services-Plus program after attending one of the sessions and felt that it was a great "insurance-type" policy to maintain his aviation career.
When he went to his urologist in June his level was 2.4 ng/ml. His doctor was concerned but since King was a good patient and coming in regularly, he made a follow-up appointment to see him in December. When he came back in December his level had risen to 3.4 ng/ml, so he performed prostate biopsies at that time. Several of the biopsies came back as cancer. His urologist spent an hour explaining all the various treatments. The common treatments are surgery to remove the entire gland and the surrounding lymph nodes. The physicians go to lengths to "spare" the nerve supply around the gland. These nerves allow a man to have erections post-operatively and avoid what is known as erectile dysfunction, which is one of the complications of the surgery. Another treatment is radiation and a third is what is know as "watchful waiting." Since prostate cancers for the most part are slow-growing tumors, some men will have their treating urologist follow the PSA levels and do regular biopsies and if necessary, scans of the prostate gland. If the tumor appears to progress, they will then have a more definitive treatment.
King elected to have the surgery to remove the gland. He called the medical certification people at AOPA just after he made his decision to have the surgery and found out that he would be grounded once he had the surgery and for six weeks afterwards. He would need to bring to his AME the results of his initial biopsies, the history, physical and discharge summaries from the hospital admission for the surgery, the operative report from the surgery, and the pathology report. He also found out that if an airman has the surgery and the pathology report from the surgery demonstrates that the tumor was confined to the gland (not spread outside the gland, which implies an increased chance for a recurrence years down the line), that this is one of the new Conditions AMEs Can Issue (CACIs). If the airman hand-carries all of the above documents that demonstrate the above, the AME may now issue without the requirement for a special issuance.
Sky King is back to flying his Cessna 310 fighting crime in Arizona!
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