April 2015 African Pilot 87Medical
urethra. Prostate cancer might only become symptomatic when it is large
enough to exert pressure on the urethra. Therefore the symptoms of BPH
and prostate cancer are similar. Other conditions such as prostatitis or a
urinary infection can also present with the same symptoms.
These symptoms include:
- A sense of urgency - having to rush to the toilet to pass urine
- Increased frequency of passing urine - especially at night
- Diffi culty passing urine - straining to start or stop the urine stream
- A weak or interrupted urine stream
- A sense of not being able to completely empty the bladder
- Inability to urinate when standing - requiring sitting during urination
- Pain when passing urine
- Blood in the urine or semen
- Loss of bladder control with coughing or laughing
- Pain with ejaculation
- Inability to get an erection
Sometimes the symptoms of prostate cancer may seem unrelated to the
prostate gland. These symptoms occur because of advanced cancer that
has already spread to other parts of the body (known as metastatic cancer).
It might be any of the following:
- Dull, progressively severe pain in the bones, especially the lower back,
hips or pelvis - Unexplained weight loss
- Fatigue
- Increasing shortness of breath while doing activities previously well tolerated.
In order to diagnose prostate cancer a combination of tests may be needed.
A rectal examination should be performed as part of a physical examination
(including during the aviation medical examination). It should be done
annually in all men over the age of 50 years. In men with other risk factors it
should be done from the age of 40. Any abnormal size, consistency, lumps
or nodules in the prostate gland may indicate prostate cancer.
The PSA (Prostate Specifi c Antigen) blood test measures the level of a
protein that is produced by the prostate gland. The PSA level on its own is
not a good indicator of prostate cancer. A low value can be falsely reassuring.
Prostate cancer can be present in patients with a low PSA level. If PSA is
elevated it can indicate cancer, but it is not diagnostic. PSA can also be
raised due to BPH, prostatitis, exercise and sex. It is more useful to track
PSA levels over a period of time to document any change than drawing
conclusions on a single measurement.
Individuals with abnormal fi ndings during a physical examination or abnormal
PSA levels should be referred to an urologist for further evaluation, which
would include a prostate biopsy. During a biopsy a sample of tissue is
taken for microscopic analysis. A biopsy can usually confi rm the diagnosis
of prostate cancer. It is an uncomplicated procedure but might cause
numbness, tenderness or pain for a while. Occasionally, there might be
blood in the urine after the procedure.
In some cases more than one biopsy might be performed e.g. if a biopsy is
normal; but the urologist is still concerned that there might be cancer. An
MRI scan might also be recommended. Once the diagnosis of cancer has
been made, additional tests will be performed to detect whether it has spread
other parts of the body. These tests might include blood tests, a chest X-ray,
abdominal ultrasound, bone scan, CT scan or MRI scan. After the extent of the
cancer has been determined possible treatment options can be considered.
The prognosis (the likelihood that the cancer can be cured by treatment and
what the patient’s life expectancy is likely to be) can also be estimated.There are several options for treatment of prostate cancer. Most often
radiation, surgery or a combination might be recommended. In the early
stage brachytherapy (implanted radio-active seeds) may be the only
treatment needed. Surgical treatment is considered appropriate for patients
where the cancer is confi ned to the prostate gland. Surgery is sometimes
unacceptable to patients due to the risk of complications. Some possible
complications include impotence (primarily dependent on whether or not the
nerves can be preserved during surgery), incontinence (due to disruption of
the sphincter or valve) and risks associated with any surgical procedure such
as blood loss, infection or the development of blood clots following surgery.Radiation therapy can be administered using X-ray machines (known as external
beam radiation therapy or EBRT). It is an alternative option to surgery. EBRT is
typically administered in brief doses, fi ve days a week for several weeks. Radiation
therapy may be given alone or in combination with hormonal therapy (which can
shrink the prostate gland thereby reducing the size of the radiation area).Radiation can also be administered using radioactive seeds implanted into the
prostate gland, known as brachytherapy. Brachytherapy may also be combined with
EBRT to further increase the dose of radiation therapy given to the prostate gland.Side effects of EBRT may include fatigue, hair loss, erection problems and
skin, bladder or rectal irritation. Brachytherapy can cause discomfort when
passing urine. 15% of men might be unable to pass urine and might need a
catheter for a few days. Brachytherapy can also cause a sensation similar
to constipation due to the swelling of the prostate gland. These effects are
usually temporary but may recur or persist after treatment. There may be
some long-term effects such as irritation of the rectum and diffi culty urinating
due to scar tissue formation. Delayed onset of impotence can also occur
after radiation therapy. There are also other treatment options which are used
less often but for specifi c indications such as cryotherapy, chemotherapy,
immunotherapy, targeted therapy and the use of radiopharmaceuticals.Pilots can apply for certifi cation after a diagnosis of prostate cancer. Each
case will be decided on individual merits by the Aero Medical Committee at
the SA CAA according to the prostate cancer protocol. The following reports
would need to be submitted as a minimum:- Current status report from the treating urologist, including treatment and
side effects of treatment - All relevant medical reports include staging of the cancer, PSA values,
blood tests, X-ray reports etc. - Operative report, if applicable
Last but not least – remember that every challenge can be better overcome
when a person has a positive frame of mind...SOURCES
http://www.cancerresearchuk.org
http://www.medicinenet.com