Why this topic is so important
If you’re of the female persuasion, you may be a little put off by AOPA’s focus the last couple of months on the subject of prostate cancer in men. It’s a very prevalent disease in men, and the list of well known celebrities who have succumbed to this illness is, sadly, a long one and includes actor Bill Bixby (from the 60’s television series “My Favorite Martian”), TV talk show host Merv Griffin, poet Robert Frost, “Law and Order” television series star Jerry Orbach, actor Dennis Hopper, Nobel Prize winner Linus Pauling, and singer/songwriters Frank Zappa and Dan Fogelberg.
Some of these well known men died in the early to mid 1990’s when prostate cancer was less well understood and treated, yet 30,000 men still die each year from a disease that is not only treatable if diagnosed early, but completely curable as well.
As Jonathan points out in his column, PSA is a protein marker by which most prostate cancers are diagnosed (along with an accurate assist from the urologist’s gloved finger!) However, as my own urologist pointed out, an elevated PSA does not necessarily mean that cancer is present. In fact, he told me that the highest PSA level he has seen in his practice was in an elderly man with a level of over 900, and he did not have prostate cancer. So the PSA is a marker, but not always a definitive one.
Just as all of us over 40 types (see, ladies, we didn’t ignore you totally!) should have periodic colonoscopies to reduce the risk of developing colon cancer (another very treatable cancer when diagnosed early), men with a family history of prostate cancer, and probably all men over age 40 or so, should have the PSA included in periodic blood work that accompanies routine annual physical examinations.
Successfully treated (or observed, since not all prostate cancers require immediate treatment), cases are favorably reviewed by the FAA, and annual special issuances that can be reissued by the aviation medical examiner are the order of the day. For cancers that require surgery, or that are followed by surgery with chemotherapy and/or radiation, all treatment should be completed before notifying the FAA. There’s no specified post treatment waiting time, but surgical patients would probably want to hold off for about six to eight weeks post op before providing any records to the FAA, although recovery from robotic surgery is generally “less eventful” and quicker than a radical prostatectomy. Chemo and radiation patients also should wait about four to six weeks to get past any post treatment side effects such as fatigue and weakness that can linger for a while after the last treatment.
The FAA wants to see basic hospital records, including the admission summary, the operative report, the pathology report, and discharge summary. They also will want to see a current narrative summary from the treating physician done just before the records are sent in, so the report will be as fresh as possible. And finally, a current PSA that is near zero or that is trending downward toward zero.
Following recertification, the FAA will ask for an annual status report from the treating physician, and a current PSA. Because prostate cancer, as most other cancers, is considered to be a disqualifying condition, a special issuance authorization will be issued annually and will continue for 2-5 years, depending on the case, after which the special issuance will be removed and a regular duration medical certificate will be issued.
September 8, 2010