Prostate cancer is the most common cancer among American men [1]. In fact, 11% of men in the United States will be diagnosed with prostate cancer in their lifetime [2]. Gentlemen, fortunately for us, prostate cancer has a five-year survival rate of 98% [2]. Most of the time it is found via a screening test called PSA (a blood test) without the person ever developing any symptoms. If present, symptoms could include urinary issues, blood in the urine, or blood in the sperm [2]. 78% of cases are isolated to the prostate at the time of diagnosis [2]. However, in 6% of the cases, cancer has already metastasized to the bones causing bone pain [2].

If you are a pilot with a history of nonmetastatic prostate cancer, you have an excellent chance of keeping your wings. If you completed treatment 5 or more years ago without recurrence or continued treatment, your AME may issue a medical certificate (if you are otherwise qualified) [3]. If your treatment was completed less than 5 years ago, your AME may be able to issue a medical certificate via a CACI (Conditions AMEs Can Issue) [3].

CACIs are common medical conditions such as Arthritis, Hypertension, and Pre-Diabetes for which your AME may issue a medical certificate if you meet the FAA’s standards. There are separate worksheets for each CACI condition which the AME can use to determine your eligibility to receive your medical certificate. If your condition meets all the requirements for a CACI and you are otherwise qualified to receive your medical certificate, you may be issued a certificate at the time of the exam.

Chance favors the prepared pilot, but the prepared pilot does not have to take chances with their medical cert. If you have a history of prostate cancer and you have completed treatment within the last 5 years, you should walk into your AME’s office with all the documents required to prove your fitness for continued flight. To qualify for a CACI you must:

1. Provide, a current detailed clinical progress note from your treating physician attesting that:
   • Your condition is stable and without spread or recurrence
   • No current metastatic disease or history of metastatic disease
   • Treatment has been completed and no additional treatment is currently required (brachytherapy may be ongoing)
   • If surgery was performed, you:
   • Are currently not on pain medication
   • Are fully recovered; and
   • Have been released by the surgeon
2. Provide a PSA within the last 6 months that meets the following standards
   • 0.2 or less after prostatectomy
   • 20 or less without prostatectomy
3. Be symptom free

The day of the exam is NOT the time to figure out you are not physically qualified. Therefore, we advocate for pre-exam planning. You should bring everything you need to prove your airworthiness to the exam. If you can prove to the AME that you are safe to fly, you will likely get your certificate. If the AME is forced to defer to the FAA, you will already have everything prepared to submit. If you need help, please reach out to us at contact@wingmanmed.com. And don’t worry, your AME shouldn’t have to glove up for you.

References:

[1] “Cancer facts for men,” American Cancer Society, 27-Aug-2021. [Online]. Available: https://www.cancer.org/healthy/cancer-facts/cancer-facts-for-men.html#:~:text=Prostate%20cancer%20is%20the%20most,over%20the%20age%20of%2065. [Accessed: 02-Jun-2022].

[2] M.-E. Taplin and J. A. Smith, “Clinical Presentation and Diagnosis of Prostate Cancer,” UpToDate, 19-May-2022. [Online]. Available: https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-prostate-cancer?search=prostate+cancer&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. [Accessed: 02-Jun-2022].

[3] “Prostate Conditions,” Guide for Aviation Medical Examiners, 14-Apr-2022. [Online]. Available: https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item41/amd/nd/prostatic/. [Accessed: 02-Jun-2022].