Biochemical Recurrence of Prostate Cancer
Answered By AOPA

I'm applying for my Third Class certification and have a question about subj. Had my prostate removed in 2016 with reportedly clean margins and PSA was negligible after that until last year, when it crept up just over the 0.2 level of biochemical recurrence. This year, it's still over the 0.2 level but not going up rapidly and my oncologist says the best course is to just wait and see if/when it goes up any further. I have zero symptoms and would like to start flight training, but wonder if this “yeah it's there but we're not going to do anything about it” status rules me out of a medical. Maybe I should just build a simulator?  

6 Replies
AOPA Staff Answer

Martin, the FAA will need to do a special issuance for you with a biochem recurrence. You will be asked for a current narrative from your treating doctor covering the items listed in the CACI worksheet.


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Does this from the FAA AME Guide describe your situation?

A. Prostate Cancer
Non metastatic with treatment completed 5 or more years ago
If NO recurrence or ongoing treatment:ISSUE
Summarize this history in Block 60.

Or does this?

C. Prostate Cancer with Metastatic disease current OR any time in the past


Recurrence of disease including a biochemical recurrence (BCR) after prostatectomy

Submit the following to the FAA review:

☐ 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).


Initial Special Issuance – Requires FAA Decision

Follow up Special Issuance will be per the airman's authorization letter

If you need help figuring out which situation is yours, call the AOPA Medical Help Desk.


Thanks Ron. I had seen the chart and am in the last category - biochem recurrence. But my question is that once you send off all the information is requesting, do they approve anybody with biochem recurrence who with medical advice is just watching and waiting to see if something more develops?

1669 Posts

For that you'd need a real expert like the folks at AOPA Medical or Dr. Bruce Chien, who drops in here periodically or can be reached at


Thank you! The fact that they have guidelines for reapproval implies that they do approve certs under my conditions. That's awesome - all the paperwork has been submitted and now I'm getting excited again :-)

1669 Posts

I think it would be more accurate to say they approve some applications.  It would have behooved you to have consulted with an expert on this type of problem (like Bruce Chien, mentioned above) to review the package before you submitted it to ensure a) it's complete, and b) it's likely to be approved.  Submitting a package which doesn't provide everything they want the way they want it, or which would not be likely to be approved, would complicate matters further.  In any event, I wish you luck and hope what you submitted will win approval.