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Old 07-03-2019, 01:38 PM   #1  
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Default Prostate Cancer

Any of you guys have experience with Prostate Cancer. I hope not, but I'd imagine a disease that effects 1 in 9 men, we tend to be be health conscious, that we will have quite a number of us on this web board.

I was diagnosed about a month ago. After speaking with my AME and AMAS, I am now back to work until such time as I start treatment. As for the FAA, they are only concerned with metastatic disease and they don't want you flying while you are being treated or effected by treatments. Your AME can CACI non-metastatic Prostate Cancer.

What type of treatment are guys seeking? I am too young, 49, and have 3+4 Gleason, so Active Surveillance is probably not a viable long term option for me. I am leery of surgery since there are several treatments with comparable outcomes that have significantly reduced side effects.
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Old 07-03-2019, 04:14 PM   #2  
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Any of you guys have experience with Prostate Cancer. I hope not, but I'd imagine a disease that effects 1 in 9 men, we tend to be be health conscious, that we will have quite a number of us on this web board.

I was diagnosed about a month ago. After speaking with my AME and AMAS, I am now back to work until such time as I start treatment. As for the FAA, they are only concerned with metastatic disease and they don't want you flying while you are being treated or effected by treatments. Your AME can CACI non-metastatic Prostate Cancer.

What type of treatment are guys seeking? I am too young, 49, and have 3+4 Gleason, so Active Surveillance is probably not a viable long term option for me. I am leery of surgery since there are several treatments with comparable outcomes that have significantly reduced side effects.
What is your stage and PSA level? It makes a difference.
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Old 07-04-2019, 10:19 AM   #3  
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PSA is 4.0-4.5 in 3 most recent tests.

Gleason score was 3+4=7 in 1 of 18 cores. Less than or equal to 5% pattern 4. GG2.
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Old 07-04-2019, 11:23 AM   #4  
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PSA is 4.0-4.5 in 3 most recent tests.

Gleason score was 3+4=7 in 1 of 18 cores. Less than or equal to 5% pattern 4. GG2.

This is worth reading if you haven’t already:

https://www.cancer.org/treatment/und...pathology.html


Grade group 2 is generally favorable. Not MOST favorable, but generally favorable.

The conventional wisdom is you are a Stage 1 until proven otherwise. Have any imaging studies (CT, MRI, or bone scan) been suggested by your oncologist? Are other blood studies normal? If so you would sort of fall into the group where active surveillance is a reasonable option but if you aren’t the sort who does well emotionally (and a lot of pilots aren’t) more definitive treatment (ie, radical prostatectomy or radiotherapy) is not an unreasonable option.

And while I don’t mind being a sounding board, what you REALLY need is to find a good clinic that does urological oncology and get a second opinion from THEM.

Second opinions on serious medical issues are never a bad idea, and generally going to a place - like a teaching hospital - with a good reputation for specializing in that area is a better bet than asking anonymous pilots on APC., present company included.

Good luck and get copies of everything for the FAA medical guys.
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Old 07-04-2019, 12:06 PM   #5  
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I am leery of surgery since there are several treatments with comparable outcomes that have significantly reduced side effects.
From current American Academy of Urology recommendations:

Clinicians should not add androgen deprivation therapy (ADT) to radiotherapy for low-risk localized prostate cancer, except to reduce the size of the prostate for brachytherapy. (Strong Recommendation; Evidence Level: Grade B)

Clinicians should inform low-risk prostate cancer patients considering whole gland cryosurgery that consequent side effects are considerable and survival benefit has not been shown in comparison with active surveillance. (Conditional Recommendation; Evidence Level: Grade C)

Clinicians should inform low-risk prostate cancer patients who are considering focal therapy or high-intensity focused ultrasound (HIFU) that these interventions are not standard care options because comparative outcome evidence is lacking. (Expert Opinion)

Clinicians should inform patients with intermediate-risk prostate cancer who are considering focal therapy or HIFU that these interventions are not standard care options because comparative outcome evidence is lacking. (Expert Opinion)

Clinicians should consider staging unfavorable intermediate-risk localized prostate cancer with cross-sectional imaging (CT or MRI) and bone scan. (Expert Opinion)

Clinicians should recommend radical prostatectomy or radiotherapy plus ADT as standard treatment options for patients with intermediate-risk localized prostate cancer. (Strong Recommendation; Evidence Level: Grade A)

Clinicians should inform patients that favorable intermediate-risk prostate cancer can be treated with radiation alone, but that the evidence basis is less robust than for combining radiotherapy with ADT. (Moderate Recommendation; Evidence Level: Grade B)

Clinicians should inform patients with intermediate-risk prostate cancer who are considering focal therapy or HIFU that these interventions are not standard care options because comparative outcome evidence is lacking. (Expert Opinion)

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Old 07-04-2019, 12:11 PM   #6  
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Most men die with it than from it. The vast majority of the time it isn't a big deal. Be sure to get a second opinion.

My dad had it at age 57 but it was so small it wasn't even worth treating. However the first doctor was getting ready to do all sorts of stuff to him in order to "treat" it. Fortunately my mom sought a second opinion first.

In the end he died 10 years later from an aneurysm having received zero treatment for the prostate cancer.

If you're mobile, I would highly recommend these guys... I have several friends and family members who have gone there with very successful results. They are one of the best cancer centers in the world and just minutes from TPA: https://moffitt.org/
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Old 07-04-2019, 12:36 PM   #7  
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Most men die with it than from it. The vast majority of the time it isn't a big deal. Be sure to get a second opinion.

My dad had it at age 57 but it was so small it wasn't even worth treating. However the first doctor was getting ready to do all sorts of stuff to him in order to "treat" it. Fortunately my mom sought a second opinion first.

In the end he died 10 years later from an aneurysm having received zero treatment for the prostate cancer.

If you're mobile, I would highly recommend these guys... I have several friends and family members who have gone there with very successful results. They are one of the best cancer centers in the world and just minutes from TPA: https://moffitt.org/
Or if you are in the Northwest:

https://www.seattlecca.org/diseases/...econd-opinions
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Old 07-05-2019, 10:16 AM   #8  
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This is worth reading if you havenít already:

https://www.cancer.org/treatment/und...pathology.html


Grade group 2 is generally favorable. Not MOST favorable, but generally favorable.

The conventional wisdom is you are a Stage 1 until proven otherwise. Have any imaging studies (CT, MRI, or bone scan) been suggested by your oncologist? Are other blood studies normal? If so you would sort of fall into the group where active surveillance is a reasonable option but if you arenít the sort who does well emotionally (and a lot of pilots arenít) more definitive treatment (ie, radical prostatectomy or radiotherapy) is not an unreasonable option.

And while I donít mind being a sounding board, what you REALLY need is to find a good clinic that does urological oncology and get a second opinion from THEM.

Second opinions on serious medical issues are never a bad idea, and generally going to a place - like a teaching hospital - with a good reputation for specializing in that area is a better bet than asking anonymous pilots on APC., present company included.

Good luck and get copies of everything for the FAA medical guys.
Good points. Thanks.

I have had a nuclear bone scan and a contrasted CT, both clear of any metastatic disease. I do have an appointment (7/31/18, 8 weeks post biopsy) to have a 3T MRI. I also had my biopsy slides sent to Johns Hopkins for a second reading in which they pretty much concurred with the local pathologist (1/18 cores with 3+4, 20% involved and 5% pattern 4 activity.) I have been staged T1A or T1C. I need to have my urologist send my biopsies for genomic testing.

When/if I pull the trigger, I am not adverse to traveling for treatment. Right now, leery of radical prostatectomy, and leaning toward MRI guided, focal ablation therapy if the lesion is visible on MRI, or toward Proton treatment if indicated by genomic testing to be aggressive flavor of cancer.

Active Surveillance is enticing, but given my age, 49, I don't know. There are no numbers/data for such age and I am curious as to the number of contrasted/nuclear scans a guy can have before getting heavy metal diseases. Right now it is a tool for time until such time I discover a treatment that I can stomach.

Do you guys know if the FAA would balk at non-FDA approved procedures performed in Europe? Tho, FLA/HIFU are now approved, and I believe TULSA PRO trials have been completed and rumored to be available "soon."

And, only a month into this, I can concur the need for second opinions and being your own advocate. Had I followed the advice of my Urologist, I'd be a couple weeks post op already. He has since admitted that I have plenty of time to do due diligence.

Appreciate the insight fellas!!
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Old 07-05-2019, 02:04 PM   #9  
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Active Surveillance is enticing, but given my age, 49, I don't know. There are no numbers/data for such age and I am curious as to the number of contrasted/nuclear scans a guy can have before getting heavy metal diseases. Right now it is a tool for time until such time I discover a treatment that I can stomach.
It’s not that information isn’t available, it’s that it’s sort of a philosophical issue depending on the philosophy of the patient. Like some people put money in stocks and some put money in bonds. The same answer isn’t necessarily “right” for two people, even with identical pathology.

As for the contrast/nuclear scan and heavy metal disease issue, that I CAN reassure you about. I used to fly radioisotopes and Technetium-99m generators through the mountains at night in ancient piston twins older than I was. Diagnostic isotopes are actually pretty benign. The brachytherapy “seeds” require a little more caution.


https://www.health.harvard.edu/blog/...s-201605279667

https://www.urotoday.com/conference-...veillance.html

https://www.urotoday.com/conference-...sease-con.html

https://www.urotoday.com/conference-...sease-con.html






Quote:
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Do you guys know if the FAA would balk at non-FDA approved procedures performed in Europe? Tho, FLA/HIFU are now approved, and I believe TULSA PRO trials have been completed and rumored to be available "soon."
As long as you are metastasis free, I’m pretty sure they aren’t going to care. If you aren’t met free, you have bigger problems than the FDA.

The company that owns the rights to TULSA-PRO is promoting it heavily, but so did the company with the rights to OxyContin, and look how that turned out. But there are a few ongoing trials that you may meet inclusion criteria for if you want to be a guinea pig. The problem is you can’t get data on five year follow up for...well, five years, so ....well, you see the problem.

https://www.urotoday.com/clinical-tr...te-cancer.html
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Old 07-07-2019, 02:27 PM   #10  
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Appreciate the links. Still a lot to research. Iím only a month into this and have time before having to pick a treatment plan. Seems as if technology advancements are moving quickly. So, while never a good time to get cancer, I do think opportunities are much better today than ever before...tho, like life, there isnít any single treatment in which is 100% curative and 100% without side effects.
Again, thanks for the info and links!!
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