Disability Doc

13.24 Prostate gland— carcinoma.

A. Progressive or recurrent despite initial hormonal intervention.

“Hormonal intervention” for prostate cancer is any medical treatment that lowers androgen (male hormone) levels. If carcinoma of the prostate tumor progresses or recurs despite initial hormonal intervention, the prognosis is poor.

Carcinoma of the prostate that progresses or recurs despite chemotherapy or radiation given as the initial treatment my still respond to hormonal therapy. Therefore, failure of prostate cancer to respond to chemotherapy or radiation does not have the same significance as failure to respond to hormonal therapy and cannot be used to equal 13.24 A.

The intent of this listing is that the cancer must be resistant to hormonal therapy before it can be considered of listing-level severity. This is why the listing uses the wording “despite initial hormonal intervention,” rather than “following initial hormonal intervention.”

Often, hormonal therapy for prostate cancer is given on an ongoing basis for an indefinite period. The listing is met when the disease progresses or recurs while on initial hormonal therapy. To meet this listing, the person must be receiving hormonal treatment. Or the listing would be met if the tumor continues to progress if the initial hormonal therapy was stopped and restarted for some reason.

Progression of prostate carcinoma should be decided based on the evaluation of all appropriate signs and symptoms. SSA opines that serial PSA (prostate-specific antigen) levels can help assess disease activity, but cannot be used to document progression without additional corroborating evidence, such as radiologic studies or findings on physical examinations. While a rise in serial PSA level reflects does reflect ongoing disease activity, be sure the medical evidence corroborates progression or recurrence. If this issue is not clear, contact the treating source for clarification.

OR

B. With visceral metastases.

“Visceral metastases” is metastases to non-bone structures, such as the liver or lung.

“Metastatic disease” is disease that has spread through the blood or lymphatic system. For prostate cancer, extension to the intestines or rectum is usually through direct extension; and, if so, SSA opines this does not necessarily represent metastatic disease. Though I think this opinion is wrong, and it could easily be argued that direct extension of prostate cancer to structures, such as the intestines, represents “visceral metastases.”