Prostate cancer

Guidance for medical examiners when assessing a patient for either a general topic or condition - Prostate cancer.

Aeromedical implications

Fatigue and jet lag will tend to aggravate any adverse effects of radiotherapy and chemotherapeutic agents
Hypoxia - lowers seizure threshold and thus risk from cerebral secondaries

Overt incapacitation
- pain from bony metastasis
- pain from acute bladder obstruction
- neurologic deficits from spinal cord compression
- lower extremity pain and oedema due to obstruction of venous and lymphatic tributaries by nodal metastasis
Subtle incapacitation
- depression and affective disorders.

Medication side-effects
Distraction due to treatment and symptoms eg pain and nausea:
- distraction due to urinary incontinence secondary to prostate surgery
- distraction due to rectal irritation secondary to radiotherapy.

Absence of significant side-effects
- rectal irritation
- adverse effects of androgen suppression.

Confirmed diagnosis
Clinical status
- presenting symptoms/signs
- progress
Investigations conducted (if performed)
- results of staging investigations/histology:
  - collated PSA
  - biopsy results
  - percentage of biopsy cores positive for cancer
  - gleason score
- surgical report
  - clinical tumour stage
  - involved margins/ Extra-prostatic involvement
  - gleason score
- imaging for metastasis
  - bone scan
  - CT scan of the abdomen and pelvis
- follow-up investigations
Management
- treatment and response (if performed)
  - Radical prostatectomy
  - Radiation therapy
  - Active surveillance
  - Androgen deprivation therapy (ADT)
- side-effects
  - Current state of continence
  - Rectal complications
  - Adverse effects of androgen suppression
- monitoring
  - Serial PSA
Prognosis
- risk of possible future recurrence
- what are the likely clinical presentations of recurrence?
- could this be accompanied by incapacitating symptoms?
- could a recurrence be detected before symptoms occur by increasing the frequency of radiological, haematological or other surveillance?
Follow-up plan.

Additional information as required:

Investigations conducted (if performed)
Management
- treatment and response (if performed)
- side-effects
  - current state of continence
  - rectal complications
  - adverse effects of androgen suppression (e.g. mood, glucose intolerance)
- monitoring
Prognosis
Risk of possible future recurrence
- what are the likely clinical presentations of recurrence?
- could this be accompanied by incapacitating symptoms?
- could a recurrence be detected before symptoms occur by increasing the frequency of radiological, haematological or other surveillance?
Follow up plan.

Audit requirements will apply as follows
- successful and definitive prostate cancer treatment - 5 years
- people who are being monitored without treatment - ongoing
- metastatic prostate cancer in remission - ongoing
Hormonal treatment has multiple side-effects and may require additional reports and testing.

Any relapse mandates grounding and must be reported to the DAME or CASA
Any change of treatment mandates grounding and must be reported to the DAME
Side effects of erectile dysfunction medications can be aero-medically significant
Prostate biopsy may be complicated by bleeding, infection and urinary obstruction:
- most obstructions occur in the first few hours after the procedure, however there are instances where it has occurred up to 5 days later
- grounding for 5 days post procedure is required to reduce the risk of in-flight incapacitation.

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The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

Last updated: 30 March 2021