Prostate Cancer

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

Aeromedical implications

Effect of aviation on condition

  • 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

Effect of condition on aviation

  • 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.

Effect of treatment on aviation

  • 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.

Approach to medical certification

Based on the condition

  • Absence of symptoms / complications
  • In remission / acceptable staging
  • Acceptable biochemical and haematological parameters

Based on treatment

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

Demonstrated stability

  • Stability of treatment and condition confirmed for the period of certification
  • May include interim surveillance eg review of PSAs by DAME

Risk assessment protocol - information required

New cases

  • 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. 

Renewal

  • Clinical status
    • any symptoms/signs
    • progress (as indicated by serial PSA’s).

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.

Indicative outcomes

  • 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.

Favourable

  • Prostate cancer - successfully treated or localised and stable PSA
  • No significant consequences of treatment

Unfavourable

  • Metastatic cancers
  • Unstable cancers requiring radiotherapy or chemotherapy
  • Adverse effects of androgen suppression

Pilot information

  • 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.

Feedback

We value your feedback.

Disclaimer

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

Last updated:
Back to top of page