post radical prostectomy
Answered By AOPA
If you had your prostate removed and there were clean margins and no extension into the lymph glands, in other words, you are demonstrably cancer-free, how soon could you return to flight and what form would my surgeon need to help me with this? 

And yes, I know it isn't this easy, but am hopeful anyway...
11 Replies
AOPA Staff Answer
As Ron and Bruce have said, usually once you have been cleared by your doctor and treatment is complete then you can continue to self assess and then report the prostate cancer at your next medical. If you meet the CACI criteria that Ron posted then just make sure that you have a status letter from your treating physician and the results from a PSA (no older than 6 months) with you when you go in to see the AME. 

If the prostate cancer was metastatic then the AME will have to defer your case to the FAA for review. They'll need to see:

☐ Current status report from oncologist describing treatment plan, how long the condition has been stable, and prognosis;

☐ List of medications and presence or absence of side effects with specific attention to any chemotherapy, steroids, or hormone agents and dates used;

☐ Treatment records including clinic notes or a summary letter describing initial staging, disease course, locations of metastatic disease, and stability;

☐ Operative notes and discharge summary, if applicable;

☐ Pathology report(s), if applicable; and

☐ Results of MRI/CT or PET scan reports. (In some cases, the actual CDs will be required in DICOM format for FAA review).

The official FAA guidance is here. The form the AME will use to decide is here. That first block in the CACI form tells you what your treating physician will have to put in the Status Report you take to the exam with the AME.  If you meet those criteria, you can be back in the cockpit as soon as you complete a new FAA medical exam.

And if you don't meet those criteria, don't go for the FAA medical exam until you do.  Beyond that, ask Dr. Bruce Chien, who will probably chime in later tonight.
Thank you! That's more encouraging than I expected.
You need proof either from the pathology report or an MRI (done during staging pre op) that "elvis never left the building". If you have that you retain that proof and return to fly when your doc sez it's okay with him. Now, "not into the nodes: isn't the same thing as "never penterated the capsule.  Be very careful here.

At the next medical the AME needs enough infomration to declare that "Elvis never left the building" and he makes the CACI statement, and issues you the certificate.
But I think maybe it did penetrate the capsule. They were only able to save one nerve. What then has to happen before I can take this to the AME?
Boomer At AOPA:
As Ron and Bruce have said, usually once you have been cleared by your doctor and treatment is complete then you can continue to self assess and then report the prostate cancer at your next medical.

That's not what I said.  Since cancer is a disqualifying condition, per 61.53(a)(1),  he is grounded until he gets a new issuance.

Thanks, guys! I guess we'll see what the future brings. I remain somewhat hopeful that the cancer did not penetrate outside the capsule.
So Ron is correct if you need the special issuance.  But you might not.  The critical thing is to get that pathology report reviewed by someone who knows this stuff. But in any case the SI for local spread prostate CA is fairly straightforward to get esp if you PSA has become undetectable.....
I asked my surgeon if the cancer had spread beyond the capsule and he wrote this:
"No capsular penetration and surgical margins were negative (meaning no tumor at the margin of the resection. this is a good thing)."

The question is, does that mean the AME still needs the MRI, PSA and all the other studies to go along with the form that was mentioned here at the start? Or can he just tick off the boxes and hand it to my AME?

No it means he either has to write that in a letter to your AME, or you have him print and check the boxes, sign this and you HAND it to the AME.