Prostate Cancer

Sport Aviation, June 1998

Dear EAA,

Reference the two articles in Sport Aviation concerning prostate cancer. I hope my experiences over the past six years will enlighten your readers and possibly save some of them unnecessary anxiety and discomfort (biopsies are uncomfortable!).

First, select your urologist with care, only after determining his attitudes regarding examination, testing, and evaluation. Some will recommend a biopsy promptly after any PSA reading above four, while others do so only if the reading seems high relative to prostate size, if it continues to rise in subsequent tests, or if an anomaly is detected by sonogram. Mine (unfortunately) was among the first group and from May 1992 to April 1993 I underwent a total of eight needle biopsies. The lab results passed to me by the doctor’s office only stated that "all were benign."

In the meantime, I came across an article stating that as high as 20% of the PSA tests produce false results (both positive and negative), and that prostatitis can produce PSA readings as high as 100! After that, I requested copies of the pathology reports on my biopsies and, sure enough, one referred to "focal prostatitis" and the other "chronic non-specific prostatitis." Since none of this was communicated to me or any treatment offered for that condition, needless to say I have changed urologists!

Also, by early 1996 (again by reading), I discovered another blood test called "Free PSA." This was developed to screen the PSA test results for false readings. Its product is a percentage figure. Ten or below indicates that no matter what the PSA result is, cancer is not likely involved. Above ten, the probability of cancer increases with the reading.

I trust that these "lessons learned" can be communicated to your readers, as it is hard to find all of these factors presented in any one place.

Ted Stanfill, EAA 12390, Alexandria, VA

(Editors note: It is important to emphasize that the decision about what treatment to follow is a cooperative effort involving the patient, his family and his physician. All should contribute their best efforts to a decision agreed upon by all, not dictated by one. – Jack Hastings, Chairman, EAA Aeromedical Council)

Sport Aviation, July 1998

Dear Sir

As an AME and a urologist, I read with interest the comments of Mr. Stanfill in the June 1998 issue of Sport Aviation. I applaud your efforts at informing your readers about issues that affect their aviation lives. However, it would be good if you ran the letters past an "expert" before going to print just to be sure the facts are correct. It is here that I have to take exception to Mr. Stanfill’s comments. He correctly identifies "Free PSA" as another test to aid in the detection of prostate cancer. He is also correct in stating that it is expressed as a percentage. However, his comment that "ten or below indicates that no matter what the PSA result is, cancer is not likely involved" is absolutely in error. It is analogous to flying a "back course localizer approach." Everything is backwards. In fact, the detection rate of prostate cancer at biopsy in men with Free PSAs below 10% is about 8 times higher than for men with Free PSA above 30%. In truth, the higher the percentage of Free PSA, the lower the risk of prostate cancer. Prostate cancer is rarely found at biopsy when the Free PSA is 30%. For this reason, most urologists now recommend biopsies for men with Free PSAs below 25%, when the PSA is between 4 and 10.

I hope this explanation helps your readers understand some of the finer points about Free PSA in the detection of prostate cancer. In aviation parlance, we’re somewhere past the Wright brothers, but we’re not up to the Space Shuttle yet when it comes to detection and treatment of prostate cancer.

Douglas E. Claybrook, M.D., EAA 372030, Terre Haute, IN