Prostate cancer
What the FAA's documents say about prostate cancer, in plain words, with the FAA's own words one press away.
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AProstate cancer, non metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence or ongoing treatment. | Examiner issues | Examiner can issue |
| Row BProstate cancer, non metastatic, with treatment completed less than five years ago, or active surveillance or watchful waiting. | Worksheet | CACI |
| Row CProstate cancer with metastatic disease, current or at any time in the past, or a recurrence of disease, including a biochemical recurrence (BCR) after prostatectomy. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Prostate cancer
- Row A · Examiner can issue
Prostate cancer, non metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence or ongoing treatment. The table says ISSUE, and has the examiner summarize this history in Block 60.
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.
- Row B · CACI
Prostate cancer, non metastatic, with treatment completed less than five years ago, or active surveillance or watchful waiting. The table sends the examiner to the CACI worksheet for prostate cancer, and has the examiner note it in Block 60.
Non metastatic with treatment completed less than 5 years ago or active surveillance / watchful waiting. … Follow CACI worksheet. … Follow the CACI – Prostate Cancer Worksheet . Note in Block 60.
- Row C · Special Issuance
Prostate cancer with metastatic disease, current or at any time in the past, or a recurrence of disease, including a biochemical recurrence (BCR) after prostatectomy. The examiner defers. The table says an initial Special Issuance requires an FAA decision, and a follow-up Special Issuance will be per the pilot's authorization letter.
Prostate Cancer with Metastatic disease current OR any time in the past OR … Recurrence of disease including a biochemical recurrence (BCR) after prostatectomy … DEFER Initial Special Issuance – Requires FAA Decision … Follow up Special Issuance will be per the airman's authorization letter
- A note on the table, 1
The table's note says that if the pilot is currently on radiation or chemotherapy, the treatment course should be completed before medical certification can be considered.
Notes : If the airman is currently on radiation or chemotherapy, the treatment course should be completed before medical certification can be considered.
- A note on the table, 2
The worksheet's note says that if it has been five or more years since the pilot had any treatment for this condition, with no history of metastatic disease and no reoccurrence, CACI is not required, and the examiner notes this in Block 60 (the note points to the disposition table).
Notes: If it has been 5 or more years since the airman has had any treatment for this condition, with no history of metastatic disease and no reoccurrence, CACI is not required. Note this in Block 60. (See disposition table.)
The FAA pathways for prostate cancer
- How this pathway works: Examiner can issueNo special pathwayRow A
- How this pathway works: CACIConditions AMEs Can IssueRow B
- How this pathway works: Special IssuanceAuthorization for Special Issuance of a Medical CertificateRow C
- How this pathway works: AASIAME Assisted Special IssuanceAfter the FAA decides
Which exam
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what it verifies.Within 90 days before the examOne question insideA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
It verifies
- Stable, with no spread or recurrence
- No current or historical evidence of any metastatic disease
- Active treatment (chemotherapy, radiation, etc.) completed, with no further treatment recommended at this time
After surgery
- Off pain medications
- A full recovery
- Released by the surgeon
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
Condition is stable with no spread or recurrence;
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
There is no current or historical evidence of any metastatic disease;
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
Active treatment is completed (Chemotherapy/radiation, etc.) and no further treatment is recommended at this time; and
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
If surgery has been performed, the airman Is off pain medications; Has made a full recovery; and Has been released by the surgeon [ ] Yes
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
Step 2: A current PSA
The PSA within the last 6 months, and the level the worksheet accepts.A current PSA, within the last 6 months.
The worksheet accepts
- 20 or less, if no prostatectomy
- 0.2 or less, after prostatectomy
Show the FAA's words: A current PSA
Current PSA (within the last 6 months) [ ] 20 or less if no prostatectomy
[ ] 0.2 or less after prostatectomy
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
Step 3: The worksheet's criteria
Your current treatment, and symptoms.No current treatment, or active surveillance or watchful waiting, or brachytherapy.
The worksheet's other criteria
- No symptoms
Show the FAA's words: The worksheet's criteria
Current treatment
[ ] None or active surveillance/watchful waiting or Brachytherapy
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA
Symptoms [ ] None
FAA source: CACI – Prostate Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says ISSUE, and has the examiner summarize this history in Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for prostate cancer, and has the examiner note it in Block 60.
Row CDefers to the FAASpecial Issuance
The examiner defers. The table says an initial Special Issuance requires an FAA decision, and a follow-up Special Issuance will be per the pilot's authorization letter.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Prostate cancer, non metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence or ongoing treatment. The table says ISSUE, and has the examiner summarize this history in Block 60.
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.
- Row B · CACI
Prostate cancer, non metastatic, with treatment completed less than five years ago, or active surveillance or watchful waiting. The table sends the examiner to the CACI worksheet for prostate cancer, and has the examiner note it in Block 60.
Non metastatic with treatment completed less than 5 years ago or active surveillance / watchful waiting. … Follow CACI worksheet. … Follow the CACI – Prostate Cancer Worksheet . Note in Block 60.
- Row C · Special Issuance
Prostate cancer with metastatic disease, current or at any time in the past, or a recurrence of disease, including a biochemical recurrence (BCR) after prostatectomy. The examiner defers. The table says an initial Special Issuance requires an FAA decision, and a follow-up Special Issuance will be per the pilot's authorization letter.
Prostate Cancer with Metastatic disease current OR any time in the past OR … Recurrence of disease including a biochemical recurrence (BCR) after prostatectomy … DEFER Initial Special Issuance – Requires FAA Decision … Follow up Special Issuance will be per the airman's authorization letter
The CACI worksheet's criteria
Progress note
It verifies
- Stable, with no spread or recurrence
- No current or historical evidence of any metastatic disease
- Active treatment (chemotherapy, radiation, etc.) completed, with no further treatment recommended at this time
After surgery
- Off pain medications
- A full recovery
- Released by the surgeon
PSA
- 20 or less, if no prostatectomy
- 0.2 or less, after prostatectomy
Your current treatment for prostate cancer
- No symptoms
Show the FAA's words: the CACI worksheet's criteria for Prostate cancer
- Stable, with no spread or recurrence
FAA criterion: the progress note verifies the condition is stable with no spread or recurrence.
The treating physician’s current, detailed Clinical Progress Note verifies: … Condition is stable with no spread or recurrence;
- No current or historical evidence of metastatic disease
FAA criterion: the progress note verifies there is no current or historical evidence of any metastatic disease.
The treating physician’s current, detailed Clinical Progress Note verifies: … There is no current or historical evidence of any metastatic disease;
- Active treatment completed, with no further treatment recommended
FAA criterion: the progress note verifies active treatment (chemotherapy, radiation, etc.) is completed and no further treatment is recommended at this time.
The treating physician’s current, detailed Clinical Progress Note verifies: … Active treatment is completed (Chemotherapy/radiation, etc.) and no further treatment is recommended at this time; and
- If surgery has been performed, off pain medications, a full recovery and released by the surgeon
FAA criterion, where surgery has been performed: the progress note verifies the pilot is off pain medications, has made a full recovery, and has been released by the surgeon.
The treating physician’s current, detailed Clinical Progress Note verifies: … If surgery has been performed, the airman Is off pain medications; Has made a full recovery; and Has been released by the surgeon [ ] Yes
- A current PSA, within the last 6 months
FAA criterion: a current PSA, within the last 6 months, of 20 or less if there has been no prostatectomy, or 0.2 or less after prostatectomy.
Current PSA (within the last 6 months) [ ] 20 or less if no prostatectomy … [ ] 0.2 or less after prostatectomy
- No symptoms
FAA criterion: no symptoms.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA … Symptoms [ ] None
If the examiner defersSpecial Issuance
The table's last row is prostate cancer with metastatic disease, current or at any time in the past, or a recurrence of disease including a biochemical recurrence (BCR) after prostatectomy, and the table marks it DEFER.
What the FAA lists to send
- Item 1. A current status report from the oncologist describing the treatment plan, how long the condition has been stable, and the prognosis.
- Item 2. A list of medications and the presence or absence of side effects, with specific attention to any chemotherapy, steroids or hormone agents and the dates used.
- Item 3. Treatment records, including clinic notes or a summary letter describing the initial staging, the disease course, the locations of metastatic disease, and stability.
- Item 4. Operative notes and the discharge summary, if applicable.
- Item 5. Pathology reports, if applicable.
- Item 6. Results of MRI or CT, or PET scan reports. The table says in some cases the actual CDs will be required in DICOM format for FAA review.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row is prostate cancer with metastatic disease, current or at any time in the past, or a recurrence of disease including a biochemical recurrence (BCR) after prostatectomy, and the table marks it DEFER.
Prostate Cancer with Metastatic disease current OR any time in the past OR … Recurrence of disease including a biochemical recurrence (BCR) after prostatectomy … DEFER Initial Special Issuance – Requires FAA Decision
What the FAA lists to send
- Item 1
A current status report from the oncologist describing the treatment plan, how long the condition has been stable, and the prognosis.
Submit the following to the FAA review: … Current status report from oncologist describing treatment plan, how long the condition has been stable, and prognosis;
- Item 2
A list of medications and the presence or absence of side effects, with specific attention to any chemotherapy, steroids or hormone agents and the dates used.
List of medications and presence or absence of side effects with specific attention to any chemotherapy, steroids, or hormone agents and dates used;
- Item 3
Treatment records, including clinic notes or a summary letter describing the initial staging, the disease course, the locations of metastatic disease, and stability.
Treatment records including clinic notes or a summary letter describing initial staging, disease course, locations of metastatic disease, and stability;
- Item 4
Operative notes and the discharge summary, if applicable.
Operative notes and discharge summary, if applicable;
- Item 5
Pathology reports, if applicable.
Pathology report(s), if applicable; and
- Item 6
Results of MRI or CT, or PET scan reports. The table says in some cases the actual CDs will be required in DICOM format for FAA review.
Results of MRI/CT or PET scan reports. (In some cases, the actual CDs will be required in DICOM format for FAA review).
After the FAA decides
AASIThe table says a follow-up Special Issuance will be per the pilot's authorization letter. The FAA's AASI sheet for prostate cancer says an FAA physician provides the initial certification decision and grants the Authorization, and that for a first-time AASI application, with all the medical information needed for a determination, the examiner must defer and submit all of it to the AMCD or RFS for the initial determination.
Show the FAA's words: after the FAA decides
Follow up Special Issuance will be per the airman's authorization letter
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401 . … If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under an FAA Authorization, the FAA's AASI sheet for prostate cancer lists what the pilot provides for the examiner to reissue. That is the Authorization granted by the FAA; a current status of the medical condition, to include any testing deemed necessary; and a current PSA level performed within the last 90 days. The sheet says the Authorization letter comes with attachments that specify the information the treating doctors must provide for the reissue determination.
Show the FAA's words: at later exams
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; … A current status of the medical condition to include any testing deemed necessary; and … A current PSA level performed within last 90 days.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI sheet's list for a reissue begins with an Authorization granted by the FAA.
Show the FAA's words: The Authorization granted by the FAA
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA;
A current status of the medical condition, to include any testing deemed necessary
The AASI sheet asks for a current status of the medical condition, to include any testing deemed necessary.
Show the FAA's words: A current status of the medical condition, to include any testing deemed necessary
A current status of the medical condition to include any testing deemed necessary; and
A current PSA level performed within the last 90 days
The AASI sheet asks for a current PSA level performed within the last 90 days.
Show the FAA's words: A current PSA level performed within the last 90 days
A current PSA level performed within last 90 days.
What the Authorization letter comes with
The AASI sheet says the Authorization letter comes with attachments that specify the information the treating physicians must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI sheet says the examiner must defer to the AMCD or Region if the PSA rises at a rate above 0.75 ng/ml per year, if a new treatment is initiated, or if any metastasis has occurred.
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … The PSA rises at a rate above 0.75 ng/ml per year; … A new treatment is initiated; or … Any metastasis has occurred.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
BPH or elevated PSA has its own table
A separate table on the same FAA page covers benign prostatic hypertrophy (BPH) or elevated PSA. Uncomplicated BPH with no evidence of prostate cancer is ISSUE, with the history summarized in Block 60. Its note points to the Pharmaceuticals section for medications usually allowed.
Show the FAA's words: good to know, 2
Benign Prostatic Hypertrophy ( BPH ) or elevated PSA … If the airman has findings consistent with uncomplicated BPH with no evidence of prostate cancer: … ISSUE … Summarize this history in Block 60 … Notes : See Pharmaceuticals section for list of medications usually allowed.
Recurrence, including BCR, is deferred
A recurrence of disease, including a biochemical recurrence (BCR) after prostatectomy, is in the row the table marks DEFER.
Show the FAA's words: good to know, 3
Recurrence of disease including a biochemical recurrence (BCR) after prostatectomy … DEFER Initial Special Issuance – Requires FAA Decision
Active surveillance goes to the worksheet
Active surveillance or watchful waiting is in the table's middle row, which sends the examiner to the CACI worksheet. The worksheet's box for current treatment includes it.
Show the FAA's words: good to know, 4
Non metastatic with treatment completed less than 5 years ago or active surveillance / watchful waiting. … Follow CACI worksheet.
Current treatment … [ ] None or active surveillance/watchful waiting or Brachytherapy
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Prostate Cancer Worksheet, a PDF at the FAA, in a new tab
- Prostate CancerOpen to print: Prostate Cancer, a page at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open to print: AASI – Prostate Cancer, a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.