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Prostates, clots and other thoughts
One of the lovely things about writing the “Fly Well” articles for AOPA Pilot is the emails I receive from readers. Some are plain complimentary – which is nice – some contain requests for further clarification and some come from medical colleagues who are, like me, passionate about aviation. When I receive such communiqués we inevitably engage in lengthy discourse about some highly specific component of the topic I have tackled. Often this would be of no interest to a general audience. However, a couple of points have popped up of late that do merit being revisited.
Firstly, in my recent article “Pythons, figs, donuts and broccoli” (AOPA Pilot, August 2010 page, 44) I talked about prostate cancer – if you have not read it, trust me, the crazy title makes sense! One of the treatments I referenced is robotic surgery to remove the gland and this inspired some activity on my desktop! So maybe it is worth a paragraph or three to discuss this.
When dealing with any cancer, the concept is to destroy the organ in which it is growing to minimize the chance of spilling malignant cells into the local tissues or to distant sites. Such metastatic spread has to be dealt with either by drugs (chemotherapy) or hormones that interfere with the cells ability to grow in their new home (hormono or endocrine therapy). Destruction of the host organ is either done by excising it via a surgical operation or utilizing radiation delivered either by external beams or implanted “seeds.”
The prostate sits in an area of the body that impacts other bodily functions; at the base of the bladder, wrapped around the tube that conveys urine on its journey out to sea, it is also very close to those nerves involved in obtaining an erection. Surgical removal of the prostate – prostatectomy – carries the risks of impairing urinary continence and of causing failure to obtain or sustain an erection. This led to some new techniques to remove the errant gland, of which robotic surgery is one approach.
I was fortunate to have participated in the introduction of robotically-enhanced surgery back in the 1990’s and saw how imaging the inside of the belly with a laparoscope, controlled by a robot (ours was called AESOP) could provide certain real advantages for the surgeon – a better more stable view and more control. The current iteration of robotic surgery includes the above technology plus robotic arms controlled by a surgeon and which scale movement – the surgeon’s hand moves a few inches, the robotic tool inside the patient’s body moves a fraction of an inch and any unsteadiness is smoothed out. In this manner it is to be hoped that a more precise operation with less side effects will be achieved. Very, very cool technology.
Another recent observation in relation to the fig-shaped prostate is in reference to the PSA test. It turns out that if a man takes a statin drug to lower blood lipids (such as Lipitor or Crestor), non-steroidal anti-inflammatory medications (“NSAIDS’ like ibuprofen) or thiazide diuretics – so-called “water pills” to treat hypertension (e.g. hydrochlorthiazide) their PSA level may be lower than men who do not take such medications. This further underlines the need to look at PSA as just one way to look for a lurking prostate cancer and to look at trends over time rather than a single number. Of interest, researchers are checking out statin drugs and NSAIDS as possible ways to avert or treat prostate cancer!
The subject of deep venous thrombosis, DVT, was tackled in the July edition of AOPA Pilot (“Really deep, man!” page 38) and this also had the “you’ve got mail” voice working overtime. One piece of advice I offered was in relation to the potential benefit of a small daily dose of good old aspirin. In England the word “clot” means someone of diminished mental capacity – not what one wants in the cockpit. Well a DVT clot is none too welcome either so any means to prevent it should be considered. One medically qualified pilot asked me about the evidence backing up my recommendation. The truth is that the evidence is “soft” but we know that aspirin reduces the risk of a second heart attack, stroke in certain people and a body of evidence suggests it may be helpful to prevent DVT. Certainly if one has a tendency to a bleeding disorder then aspirin and other such drugs (NSAID’s, Lovenox and Plavix for instance) should be avoided or only taken under strict medical supervision. But one also has to question why one would be on such drugs and flying an airplane without appropriate Aviation Medical Examiner supervision! The point is, look at all your options, seek your family doctor and AME input and then make a decision.
Fly well and stay healthy!
September 8, 2010
