AOPA Pilot Magazine - March 2015 - 22

FLY WELL

Prostate cancer

BY DR. JONATHAN M. SACKIER

Fighting it-and the healthcare industry
PROSTATE CANCER AFFLICTS 220,000 men each year,
killing 27,000. Statistically, that would equate to five
AOPA members diagnosed each week. This takes us
to the ramp at Bolton Field in Columbus, Ohio, where
Dick Andolshek and I were talking airplanes and we
chatted about his medical issues. "Seven years ago I
was diagnosed with prostate cancer and I had radical robotic prostatectomy," Andolshek told me. "They
monitored me after surgery by measuring PSA [prostate specific antigen, a protein made by prostate tissue]
in my blood and it was great news because my score
was zero every year."
PSA is a screening tool for prostate cancer,
although doctors debate its contribution to choice and
timing of treatment-and, therefore, survival in some
men. PSA can be normal in the presence of cancer, or
elevated in the absence of cancer (from infections, or
even from riding a bike, taking testosterone, or smoking). After a prostatectomy, rising levels suggest there
may be metastases, secondary tumors in the bones,
liver, brain, or elsewhere.

He could roll over and pay for diagnostic tests himself,
but this would cost thousands of dollars and it would
be inherently wrong.

DR. JONATHAN SACKIER

is an active private
pilot who counsels
members through
the AOPA Pilot
Protection Services
Plan.

22 | AOPA PILOT March 2015

At his dark time Andolshek sought the support
from AOPA's Pilot Protection Services (PPS) for
advice on dealing with the FAA, although prostate
cancer is not a disqualifying condition. "I wanted to
keep flying. PPS was like runway lights as one breaks
through the overcast on a dark night. I must thank
my wonderful friends and fellow pilots at AOPA for
helping me navigate through this very stormy, turbulent experience."
Our hero was enjoying life and flying, but six
years after surgery, PSA was detected again-
although he had no prostate remaining. A
confirmatory test elsewhere was normal but a third
was abnormal; three tests, with three different
results, is confusing indeed.
A prudent pilot takes a low oil-pressure indication
seriously, even if a faulty gauge is suspected. Similarly,
any test showing a positive PSA after surgery demands
that a prudent physician rule out metastases because,
if found early, treatment options exist.

"My doctor at the Mayo Clinic recommended
several tests but the insurers refused to cover bone
scans, CAT scan, MRI, and a new test-Choline C-11
PET scan-that may find recurrent cancer when no
other test can," Andolshek said. "They said they were
not necessary because one of my PSA tests was negative." Consider what can happen if you ignore low oil
pressure and the engine explodes; would you shrug
your shoulders and say, "Oh, well, an engine check-up
would have been expensive."
When Andolshek called me about this I was
incensed, and we discussed some alternative strategies. Yes, he could roll over and pay for diagnostic
tests himself, but this would cost thousands of dollars and it would be inherently wrong.
In my native Britain, the National Institute for
Health and Care Excellence (NICE) advises doctors what to do based on evidence-but contrary to
popular belief, it does not mandate therapies, nor is
it a "death panel." In that system, the only deciding
factor as to whether a test should or should not be used
is the presence or absence of data. I strongly support
this approach and wish we had something similar here
in the United States. If we did, the nonsense Andolshek
endured would not have been tolerated.
Good physicians who are motivated to help
their patients obtain premium care would embrace
evidence-driven approaches such as properly investigating someone like Andolshek, and not bully him into
being denied access based on some arbitrary position,
profit motive, or bureaucratic stance.
Healthcare is like a four-legged stool; one needs a
well-motivated and informed patient (Andolshek, for
instance); a physician who is able, affable, and available;
a healthcare system that treats patients with expedience and respect; and a pharmaceutical, medical device,
and biotechnology industry sector that is encouraged to
innovate and is rewarded for doing so. It does not need
political expedience throwing a dark shadow over the
light of doing good and doing the right thing.
Andolshek did the right thing-he fought the company, which was shamed into paying for his tests. By
doing so, he made it easier for the next guy. And the
tests? They were negative, so Andolshek is once again
that highest form of life-pilot.
AOPA
EMAIL jonathan.sackier@aopa.org

AOPA Pilot Magazine - March 2015

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