PROSTATE PROS

What do men do when they have no other options? What if they don’t like the side effects? Mainstream, standard of care medicine may not always have the answer. Using off-label therapies can allow men with prostate cancer to find new ways to manage their cancer. PROSTATE PROS talks about unapproved use for approved drugs that may benefit men with prostate cancer.

Dr. Scholz:    [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.  I’m your host, Dr. Mark Scholz.

Liz:      [00:08] And I'm your cohost, Liz Graves. 

Dr. Scholz:      [00:13] Welcome to the PROSTATE PROS podcast. 

Liz:      [00:20] In past episodes we've covered a variety of options for men with prostate cancer.  This episode, we're going to consolidate some effective options that are not yet FDA approved. 

Dr. Scholz:      [00:31] Liz, as you know, we've been doing this a long time and because we only see one type of cancer, we've learned some tricks along the way.  I don't think you're going to find these things in books, or at least if you do find it in books, it's going to be mentioned in passing without much context.  I think back when I was volunteering over at USC to teach fellows in cancer, back in 1996 and Taxotere, which is one of the most effective medicines for advanced prostate cancer was just released for the treatment of lung cancer.  People were getting amazing responses from men who had lung cancer that had spread to their bones.  When I heard “bones,” of course, a light bulb went off in my head and I thought, “This might work for our prostate cancer patients.”  Indeed we found that it did.  Early reports from other practices were also showing effectiveness.  Interestingly, it wasn't until six or seven years later that the FDA finally approved Taxotere for prostate cancer.  Throughout those years, we were using Taxotere regularly with good results, but it was not an approved therapy. 

Liz:      [01:41] When I was researching for this episode, it was really hard for me to find information about this.  You Google “off-label therapy, alternative medicine,” there are tons of ads you can't really figure it out, “how would I know if a lung cancer drug would work for prostate cancer?”  How do people find this information? 

Dr. Scholz:      [02:01] I think this is sort of insider knowledge.  There are specialists throughout the country that narrowly treat one type of disease.  They talk and they meet at meetings and they share their insights.  In a clinic where there's a high volume of patients, you can quickly determine if something actually works.  You’ll know, within a few months, usually within three or four weeks even, after you start Taxotere, if the PSA is dropping and the bone scans are improving.  It is insider knowledge and it doesn't get published unfortunately, sometimes for years.  There were small phase two trials coming out about Taxotere, but it took six or seven years before the phase three trials led to FDA approval of Taxotere and prostate cancer. 

Liz:      [02:49] So this can be frustrating for patients because there are patients who are starting to run out of options, or maybe they're not liking the side effect profile and they really need to find these alternative options. 

Dr. Scholz:      [03:02] Yeah, of course the online forums are really helpful for patients and the internet is a great resource.  To illustrate, we've had patients that couldn't tolerate every three week Taxotere.  I remember a patient who came to me with the PSA over a thousand and we gave him a standard Q3 week dose of Taxotere, 70 mg/m2.   He just felt so terrible that he refused to take any further treatment.  We finally talked him into taking a much smaller dose on a weekly basis, which was not in the original format for the way Taxotere is used.  Quite surprisingly, he tolerated that nicely.  His PSA ended up dropping down to less than one, he had a multiyear remission, and unfortunately down the line developed colon cancer and passed away from that.  He survived his prostate cancer for many years.  So again, weekly Taxotere in small doses for men that can't seem to tolerate the larger doses is something that's not talked about much anymore, but is just as effective as getting the larger dose every three weeks. 

Liz:      [04:16] What other types of drugs are you using in an off-label way? 

Dr. Scholz:      [04:20] Well, until recently we were using Olaparib, which is a BRCA medicine approved for ovarian cancer, but thankfully the FDA just approved Olaparib.  This is now available for people that have the BRCA mutation.  Another medicine that is, I think, widely known in inner circles in prostate cancer is a medicine called Carboplatin.  It's an injectable type of chemotherapy that's FDA approved for the treatment of lung cancer.  It synergizes with Taxotere and Taxotere’s cousin, Jevtana.  We've seen a number of men who have become resistant to Taxotere when they have Carboplatin added in small, weekly doses, couple hundred milligrams, turn around and respond again.  Quality of life is good, usually it's a weekly or every other week infusion.  So these medicines are effective, but you may not hear about them.  It's certainly not something that's quote, FDA approved and it flies under the radar. 

Liz:      [05:28] Off-label drugs can be drugs used that are already approved for other cancers, or they can be drugs that are approved for a different stage of the same cancer.  Can you talk a little bit about how Zytiga and Xtandi can be used in an off-label way? 

Dr. Scholz:      [05:44] So both of those medicines are FDA approved for men with more advanced stages of prostate cancer.  They're both well tolerated and they're certainly effective.  It's an artifice, the way the FDA approves drugs for one stage of a disease and then refuses to approve it for another stage until studies prove that it's effective.  It's the same disease, we know it's going to be effective.  So men that have what we call High-Risk prostate cancer, in my Key to Prostate Cancer book, we talk about the AZURE stage.  These are men that have Gleason 8 or 9, PSA is above 20, or maybe seminal vesicle invasion or lymph node spread, serious cancer, but Zytiga or Xtandi, oral medicines that are commonly used for advanced prostate cancer, are sometimes covered by insurance sometimes not because it's called off-label.  These medicines are known to be effective against very advanced cancer.  Why wouldn't they be effective against an earlier stage of a more serious type of cancer?  So we often talk with our patients who are usually getting treatment with radiation and Lupron for 12 months, sort of 12 to 18 months, sort of a standard approach.  Why wouldn't we give the best available hormone medicine, which is either Xtandi or Zytiga to enhance the cure rates?  Studies are ongoing and perhaps sometime in the future, this will be the standard approach, but right now it's considered off-label. 

Liz:      [07:16] So off-label drugs deviate from the standard of care.  The standard of care is how all of the insurance companies know what drugs can be paid for certain patients.  The standard of care is determined by the NCCN guidelines.  These are consensus driven management to ensure that all patients get optimal outcomes.  So insurance companies look at those and decide, “Yes, we will pay for this specific medicine and this specific patient.” 

Dr. Scholz:      [07:48] Yes, doctors follow these criteria as well.  The general oncologists are getting so busy with over a hundred different cancers.  They really need guidelines to know what the next step is.  If one medicine stops working, what should they do to follow?  These guidelines then become sort of like the Bible and thinking outside the box sometimes is discouraged even in clinical circles. 

Liz:      [08:17] In a previous podcast episode, we talked about High-Risk prostate cancer and a couple of things that are not chemotherapy that we talked about in an off-label way are Metformin and statins. 

Dr. Scholz:      [08:29] Yeah, I'm glad you brought that up, Liz, because these medicines are really relatively nontoxic.  It's unusual for people to have to stop them because of side effects.  The studies that have been done aren't phase three studies, but the phase two studies that exist seem to show a big advantage.  For some reason, Metformin, which is FDA approved for the treatment of blood sugar issues, and the statin drugs like LIPITOR and CRESTOR, which are FDA approved for people with high cholesterol also seem to give better outcomes when it's combined with hormone therapy and radiation. Another issue, that's not going to come up as standard fare.  If I was in this sort of a situation with High-Risk prostate cancer, I would make sure I was taking these medicines until proven otherwise.  They're affordable and they're nontoxic. 

Liz:      [09:21] One thing I did find in my research was about clinical trials.  Clinical trials can be really difficult to get into, but if you look into them and you find a drug that's being used, even if you're not eligible to use it, it can be a great place to start talking about with your doctor, because clinical trials are researching other FDA approved drugs, which means your doctor can write a prescription for the drug without you having to be involved in the clinical trial.  For those of you who are eligible for clinical trials, that's easy access to get off-label drugs.  One drug that's in a ton of clinical trials right now is KEYTRUDA, but I hear you all the time prescribing this to patients, what's going on? 

Dr. Scholz:      [10:12] KEYTRUDA is the miraculous medicine that kept President Carter alive after his melanoma had spread to the brain.  When you talk about clinical trials, Merck Pharmaceuticals is studying it in probably 10 to 20 different cancer types, including prostate cancer.  But Merck has been very generous in distributing this same medicine on a compassionate use basis, which means that we only have to ask Merck Pharmaceuticals for the drug and they provide it free of charge.  This is no small thing, it's a very, very expensive medicine.  KEYTRUDA is an immune stimulating medicine. It’s infused every three weeks and has activity in prostate cancer.  It’s not yet FDA approved, but we have performed our own phase two trial.  About half the patients seem to either get PSA stabilization or decline.  It's a fascinating medicine because it works by stimulating the immune system and in some patients that effect continues even after the medicine is discontinued. 

Liz:      [11:17] If you want to learn more about KEYTRUDA, listen to our episode about immunotherapy.

Dr. Scholz:      [11:23] While we're talking about immune therapies, we should also cover Leukine, which is GM-CSF a medicine that was originally FDA approved to help people getting chemotherapy keep their immune systems strong.  Over time it was noted that some people were getting declines in PSA with this medicine.  Dr. Eric Small up at UCLA did some of the early phase two trials.  Leukine was also very popular with Charles Snuffy Myers, who is a prostate maven who retired a couple of years ago. Leukine is given by an injection like an insulin shot.  We do it three times a week and it oftentimes has no side effects at all.  It may cause some chills or some rashes sometimes, but for men that have rising PSA after surgery and are really reluctant to do hormone therapy or radiation, Leukine has achieved stabilization of PSA sometimes for years.  I don't think it will ever get FDA approved, but it is something to think about for men that have rising PSA in what we call the INDIGO category that are really reluctant to consider using Lupron or Firmagon. 

Liz:      [12:34] Dr. Scholz, it sounds like you're very creative with all of this and you have a lot of experience seeing patients and offering these options, but what do patients do that can't come see you? 

Dr. Scholz:      [12:45] I think the safest thing is to visit a reputable university center where they're doing clinical trials.  This is where a lot of the new medicines are developed and the universities have institutional review boards to make sure that what they're doing is ethical.  The problem with the universities is sometimes they're constrained by only those clinical trials.  So if you don't fit the profile of their exact clinical trial that they're offering, they may feel a little nervous about offering you something creative, but the oversight and the professional collegiality that's at the universities generally leads to a cut above in the physician quality.  Of course they do have access to some of these new medicines that aren't FDA approved yet.    

Liz:      [13:38] You can search clinicaltrials.gov to find these trials going on and find a way to search for more off-label options.  The logical next topic to follow this up with are alternative, integrative, and natural options.  But as we're running out of time, we'll talk about it on the next episode.  If you have any questions about alternative therapies, you still have time to email us before the next podcast.  You can send your questions to [email protected].  Remember to help us out by rating, reviewing, and subscribing on Apple Podcasts.  

Alex:      [13:41] Hi everyone.  This is Alex with the Prostate Cancer Research Institute.  Every year we host our prostate cancer patients and caregivers conference.  Usually that is in person, but this year it's going to be virtual and free.  On September 11th and 12th we will have prostate cancer experts speaking on treatments, side effects, and lifestyle issues.  There will be live Q & A with our doctors and our helpline team, as well as awesome giveaways.   Visit our website, pcri.org to RSVP today.

SPECIAL BONUS PODCAST with host Liz Graves.

PROSTATE PROS interviews Dr. Marc Peck about his experience with prostate cancer. He describes the ups and downs of his journey starting with his diagnosis in 2001. Join Dr. Peck as he reflects on the past 20 years of living with prostate cancer.

Liz:      [00:04] Welcome to PROSTATE PROS.  I'm your host for this episode, Liz Graves.  For this special bonus episode I spoke with a Colorado physician about his 20-year-long journey with prostate cancer. Dr. Peck's story with prostate cancer begins back in 2001 with a routine PSA test. 

Dr. Peck:      [00:26] Well, hello.  My name is Marc Peck.  I'm a family physician and urgent care physician in Colorado.  I'm going to tell my journey, or my story, about prostate cancer, which I do have.  

Liz:      [00:38] It’s my understanding that you were diagnosed around age 44. 

Dr. Peck:      [00:42] Back then routine PSAs were still in vogue.  So at 43, I got a PSA that was a little higher than expected for someone in their 40s, it was 2.6.  Everyone said just watch that, which I thought was fine.  But a year later, at age 44, it had doubled to about 5.  That's when my journey began. 

Liz:      [01:10] What happened after that?  What were the next steps that you took to figure out you had prostate cancer? 

Dr. Peck:     [01:15] The first thing that my urologist said was get a biopsy and I said, okay.  It seemed that was the standard of care back then.  I was not given any other options.  I wasn't redirected anywhere else at the time.  I went ahead and had a multiple core biopsy that showed a 3 + 3 Gleason adenocarcinoma. 

Liz:      [01:40] Now, Dr. Peck has five kids.  He had a lot on his plate and at age 44 was very young at the time of his diagnosis.  So when the urologists told him that he did indeed have prostate cancer and recommended immediate surgery to remove his prostate, Dr. Peck agreed. 

Dr. Peck:      [01:59] Yeah, I rushed right into decisions.  I read all about it.  I was too young to have prostate cancer.  What the heck?  This is a disease of guys in their 80s, or at least at that time, their 60s, which I thought was pretty old back then.  I fell for the surgical pitch right off the bat.  My surgeon said, “Oh, hey buddy, we need to do a radical prostatectomy.”  At that time, the DaVinci robotic assist prostate surgery was just in its infancy, so that wasn't an option at the time.  So a radical prostatectomy was pitched to me and I fell for it because they used the key words: “nerve sparing and this'll provide a definite cure for you with minimal downtime and based on your age, this is exactly what you have to do.”  Okay.  It sounded good to me.  I was not given any other options at all at the time. 

Liz:      [03:04] Just two months after his initial diagnosis, Dr. Peck finds himself on the operating table. 

Dr. Peck:      [03:11] I had the surgery at a little hospital west of here with two fine surgeons.  That was the beginning of my one way ticket to perdition.  Now, being a physician is an invitation to have every complication imaginable.  You know, I thought about it, I looked at the age I was at the time and how that carried a more grim prognosis.  Surgery seemed to me the best option though I wasn't given any other options.  My fault, I should have gone off and searched for options, but I wanted to get this done. 

Liz:      [03:49] Yeah, I think that is what happens to a lot of men.  It's frightening.  And you were very young when you were diagnosed and all of that kind of plays into making treatment decisions rather quickly, I would say.  

Dr. Peck:      [04:02] Right off the bat, I had a urinary catheter.  I was out of the hospital in three days, I had to have a blood transfusion.  I went home and it was a pretty rocky recovery.  I remember sitting in my bathtub with my urinary catheter hanging over the side of the tub, when I got a phone call from the urologist saying: “Uh oh, it looks like your cancer was not confined to the prostate.”  So I felt pretty awful at that time.  He said, “We'll get through this recovery period and we'll talk about next steps.”  I managed to recover somewhat from the surgery though I was still incontinent.  On the plus side I get to wear scrubs so I could hide my Foley catheter pretty nicely and resumed working within two weeks after the surgery. 

Liz:      [05:02] So, I asked Dr. Scholz to explain how or why this may have occurred. 

Dr. Scholz:      [05:08] Well of course this is a very uncommon scenario for which we're very grateful, but I would imagine that the cause would be the rooted in the fact that random biopsies can miss 20% of men with higher grade disease.  So I'd assume a situation like this they never did a multiparametric MRI.  It's always good to cross check and make sure that there's nothing additional lurking in the prostate that might've been missed by the random biopsy. 

Liz:      [05:32] After Dr. Peck’s surgery, he was dealing with incontinence and impotence and was now facing a more aggressive cancer than they had originally thought. 

Dr. Peck:      [05:42] At that time, the pathology showed that I had tumor spread to the seminal vesicles, which is a pretty messy part of the genitourinary system for a man.  It's a difficult place to excise completely even with robotic surgical techniques.  I was offered Casodex, which was part of the androgen deprivation therapy at the time.  And of course, Lupron, which everybody knows about.  I declined the Lupron, went for the Casodex.  I immediately sustained all the effects of androgen deprivation, including breast development and gaining weight and being pretty stupid on that.  But I kept up my activity and my practice.  At that time, I sustained a pretty big decline in my practice.  I was unable to continue much of my practice style, which was in the operating room, delivering babies, working in a small ski trauma center.  All of that started to fall away as I was struggling with the disease. Then continued problems post-surgically, which were incontinence, and of course, impotence right off the bat.  There was apparently no nerve-sparing for me. 

Liz:      [06:58] During this time, his PSA stayed about four.  He continued on Casodex for about a year and a half, but in 2003, his PSA began to rise again, having already gone through surgery and experimented with hormone therapy, Dr. Peck went to seek the opinion of an oncologist. 

Dr. Peck:      [07:18] He said, you need to get some radiation.  At that time, the type of radiation was called IMRT.  Where you get some tattoos on you, you have a mold for your pelvis, then for the next several weeks you have a daily radiation treatment.  He also asked me to quit being a baby and go on Lupron right away, which I was still reluctant to do.  Oh yes, I had already gone through the postsurgical side effects and the Casodex side effects.  And then whatever tiny bit of continence I had was abolished or eliminated by the radiation therapy.  The thought of going on yet another medication that would essentially castrate me was daunting at the very least.  I would visit my urologist who would give me a fairly grim prognosis at every visit, three or four times a year.  I would complain about my lack of erections.  We went through all kinds of medieval sorts of methods to fix that: injecting my penis, putting painful pellets in my urethra and trying to talk about how to manage incontinence other than using incontinent diapers.  Me, being one of those people that always made fun of Depends, now I was a true supporter of that brand.  And life went on.  I continued trying to be as active as I could. I was riding my mountain bike, trying to stay active.  But as time went on I started to shed all of my fun family practice, emergency surgical practice style until I was just doing some family practice at a much reduced schedule.  That continued on for a few years actually.  I still tried to battle and tried to avoid my urologist as much as possible because most of the time when I went to see him, he goes, “yeah, you know, you're going to die in five years.”  Well I didn't take well to that sort of news. 

Liz:      [09:29] He’s telling you you're going to die in five years.  It's now been almost 20 years now since your diagnosis.  Still maintaining hope, Dr. Peck continued to search for options.  In 2010, his oncologist ordered a scan to test for bone metastasis.

Dr. Peck:      [09:48] I was just dotted with a bone metastasis.  At that time, the recommendation was chemotherapy, androgen deprivation therapy, Lupron, and a bunch of other stuff.  Being a physician, I said, I don't want to do any of that.  So I did what a lot of desperate cancer patients do, I went looking for alternatives.  I found a place in Tijuana.  Yeah, I know all the listeners are going, “What? Really, Tijuana?”  Yeah, it was a place called Issels.  They had a pretty good marketing program and all kinds of advocates and anecdotal patient survival.  So I went and cashed out my retirement plan.  It was like $40,000 and my wife and I went down to Mexico.  At that time they did all kinds of strange things.  I got bone marrow infusions of interleukin and vitamin C injections and a complete change in my diet and elimination of alcohol.  I don't know, it was pretty messed up for my stay there which was about a month.  But my PSA at that time, I was making a joke with myself because it was in the 850 range, I was trying to get it to 1,000 just to see if I could.  But after my trip to Mexico, my PSA dropped down to 35.  Now I don't want any of the listeners to go jump into that sort of treatment plan.  That is an act of desperation.  There were a lot of desperate cancer patients where I went and many of them died while I was there.  So by no means is this a recommendation to go do that.

Liz:      [11:43] This part of Dr. Peck’s story reminded me of Ralph Blum.  Blum was Dr. Scholz’s coauthor of Invasion of the Prostate Snatchers.  Blum wrote the following about the search for alternative options: “Faith begets hope.  Hope enables belief.  Belief empowers healing.”  And I see this same hope, or as Blum refers to it as faith, in this part of Dr. Peck’s story.  In 2010, after Dr. Peck returns to the U.S. he finally decides it's time to go on Lupron.  With the Lupron keeping his cancer in check, Dr. Peck shifted his focus to managing his side effects. 

Dr. Peck:      [12:24] I continued to exercise as much as I could.  I had absolutely no continence.  So I used pads and urinary clamps and all sorts of medieval torture devices to keep me relatively dry.  I went to a urologist in Denver and they put a pump in to at least allow me erections, and I also tried to get an artificial urinary sphincter.  All of these are controlled with little gizmos in your testicles.  They're little sacks filled with normal saline.  Then all the pump devices are internally implanted in you to allow you to have some element of continence and some level of erectile function.  So the erectile function worked fine, the continence devices did not.  I had several revisions on those.  After that I sustained every single side effect of Lupron and androgen deprivation therapy. I melt pretty much every 20 minutes.  It makes my patients nervous when I walk into the room sweating, they always think I have something to hide, you know, and I'm just mopping my brow going, “Oh yeah, you'll be fine.”  Then my oncologist started to throw out all kinds of cool stuff like going on diethylstilbestrol.   

Liz:      [13:48] Diethylstilbestrol is a synthetic estrogen that is used to treat hot flashes.  It's not used very frequently today as it tends to cause blood clots and they are safer estrogen medications available. 

Dr. Peck:      [14:03] I tried cyclophosphamide with steroids, really didn't do much. 

Liz:      [14:08] Cyclophosphamide is a chemotherapy drug.  It is not administered very frequently today because modern chemotherapy drugs like Taxotere and Jevtana are huge improvements over the older types.

Dr. Peck:      [14:21] I kept having problems with my urinary sphincter and went back to the University of Colorado on the urging of my old urologist, who did the prostatectomy to see the guy who does all of these artificial urinary sphincters.  Then all hell broke loose there.  Of course I was promised an outpatient surgery and a few days later after surgery in 2012, I woke up and I was informed that I nearly lost my leg because of complications of blood clots.  This is a common association with any cancerous state because your blood gets pretty thick.  I've had multiple surgeries to try to increase or allow blood flow into my leg, which were unsuccessful ultimately.  I wear a compression garment that goes up to my hip, I’m on injectable blood thinners daily, because warfarin are the usual vitamin K poisons don't really work on people with cancer.  That put a big 90 degree turn in my activities.  I really dropped my practice down to three days a week and seeing only urgent care.

Liz:      [15:31] You had to make a lot of lifestyle changes and professional changes.  Was that difficult?  Did the emotion of having prostate cancer change your life?  Did you experience any depression or feelings of isolation? 

Dr. Peck:      [15:48] I was a grumpy guy.  It was hard on my kids.  They were expecting me to become a cloud any minute.  I was going through a pretty awful divorce.  I became an insomniac because of hot flashes and constant urination.  Depression, oh yeah.  I was on antidepressants.  You know, there's the worn out statement, whatever doesn't kill you makes you stronger.  Wow, I guess, I don't feel stronger. On a plus side it made me, maybe, a better physician.  I was certainly a lot more thoughtful and understanding, and I was able to help some men through their decisions in prostate cancer and trying to steer them towards a more sensible path and to not settle for one opinion.  That was a Lance Armstrong statement when he found out he had testicular cancer, he kept going until he found sort of the right choice for him. 

Liz:      [16:48] Then Dr. Peck's PSA started to rise again and his bone scans showed increasing mets. 

Dr. Peck:      [16:56] At that time, I went down to the University of Colorado and had a cancer trial of smallpox, and some other potions that I was injected with.   Well, it's actually a variation of smallpox—it's actually fowlpox.  I did that for several weeks.  Then I was started on another androgen deprivation therapy called enzalutamide.  I love the capsule on that because it says “the enz” on it, it doesn't say “the,” it just says “enz.” 

Liz:      [17:22] Enzalutamide is also called Xtandi and we discuss Xtandi in our episode Hormone Therapy TIPs. 

Dr. Peck:      [17:31] At that time, I started using estrogen patches.  From being an NRA member and, you know, kinda shooting guns and stuff to buying curtains and looking at wallpaper was quite a change. I didn't notice right off the bat until people started saying, “Hey man, you're not that guy anymore.”  Yeah, not being, not being the guy I was and becoming somebody different was strange.  I can tell all you guys out there who were afraid of losing their testosterone, it's not the end of the world.  It's just a different world.  The world of an 8-year-old boy, mind you.  You know, when I now look at TV shows with people kissing, I don't know what they're doing.  I don't know why they're doing it.  It's all yucky.  Pretty much, I have had a stable course since about 2016.  Staying on enzalutamide, something called Xgeva, which makes my bones pretty sturdy, and Lupron every six months.  

Liz:      [18:30] Xgeva is an oral agent that strengthens bones and can also delay cancer growth in the bones.  So now in terms of follow up, are you just getting your PSA tested every couple of months?

Dr. Peck:      [18:47] I just had a bone density test, which is not the same as a bone scan.  Our office got a new bone density checker to see how people are in terms of their osteoporosis.  And my poor tech just freaked out and said, “What is all of this? There's stuff everywhere in your skeleton.” You know, from head to toe, from skull to femurs.  The good news is my bone density is like Wolverine.  I've got like a seven in terms of bone density.  It's like rock.  I know that some of these bone mets from prostate cancers are osteolytic, horribly painful.  Mine haven’t troubled me overly much other than they're there. I try not to think about them.

Liz:      [19:34] Dr. Peck’s experience with prostate cancer is extensive.  He had surgery, beam radiation, hormone therapy, and a variety of surgeries and methods to try to manage his treatment side effects.  So remember, the way in which each patient reacts to medication and how their cancer reacts to treatment varies greatly from person to person.  There are some men on hormone therapy who have minimal side effects while others may need to revise their entire treatment plan based on experiencing too many side effects.  This is why treatment needs to be personalized to the individual.  While accurate staging helps determine treatment, so does the patient's desired quality of life.  Well, it seems like you kind of researched prostate cancer and stayed up to date with that.  That's very impressive. 

Dr. Peck:      [20:25] I had someone reach out to me who is a 59-year-old man who just discovered he had stage four prostate cancer, with a PSA of 3,000 and horrible pelvic pain.  They wanted to hear what I had to say about their prognosis.  And I just don't know what to say.  I've listened to your podcasts and I've heard the gospel that there's more than one way, there are better ways to treat prostate cancer.  And there is!

Liz:      [20:53] Access to quality care is a big topic in the medical world.  Not everyone can afford the time off work, the travel or the costs.  So I asked Dr. Scholz what people who may not have these resources can do. 

Dr. Scholz:      [21:07] Well, like any issue, looking for quality is always the important component of getting good outcomes.  Being willing to travel to another city or state is an important thing to consider.  But if a person feels absolutely stuck, then probably ensuring that you're getting consultation from both surgery and radiation therapy would be very important.  We have a nonprofit educational foundation called the Prostate Cancer Research Institute that offers a free helpline as well.  So consulting with them to try and get access to the best available treatment would be a good idea. 

Dr. Peck:      [21:46] I met a guy, one of my patients a few years ago, whose PSA was always 80 to 100 and he was real happy.  He took a whole bunch of vitamins, which he had me doing, and he's still going.  One of his famous lines is, “Oh to be 70 again.” He's been a pretty good inspirational guy, but he's one of those fellows that was able to seek out treatments all over the country to go to Sloan Kettering, to go to MD Anderson, to go to UCLA, to everywhere and get all kinds of great advice.  I’ve been sort of trailing on his advice for the last few years.

Liz:      [22:24] Dr. Peck and I discussed how he approaches PSA screening with his own patients. 

Dr. Peck:      [22:31] I do have the conversation with them.  I talk about the United States Preventative Task Force Service on getting a PSA, what it means, what are the implications, how it correlates with their age and symptoms.  I'm pretty judicial.  That’s a serious conversation I have with him.  Then if their PSA is hanky, I have the talk with them about repeating it, how to follow up on it, who to see, and what are some smarter options rather than having what I call a “misterectomy,” which is pretty much what a radical prostatectomy is.  I really think that exercise is one of the key treatments for any kind of cancer.  Certainly I really not only think like an 8-year-old now, but I have the body of an 8-year-old.  I go out and have some hand weights that I work on.  I try to walk as much as I can.  I do tai chi. I ride my mountain bike as much as I can, though I'm looking at these electric bikes pretty closely.  And my diet, I don't drink any alcohol, it just makes me feel weird.  And I think that is a direct side effect from my enzalutamide or Xtandi.  So I eat a pretty clean diet, but mostly Cheetos.  I don't know what happened there.  That seems to be helpful and may be a cure. 

Liz:      [23:53] Finally, I asked Dr. Peck what advice he would give to a newly diagnosed man, based on his own experience with prostate cancer. 

Dr. Peck:      [24:03] Take a breath.  Don't listen to the car salesman pitch of your urologists.  They mean, well, but they're surgeons and they like doing surgery.  Seek out, like Star Trek, new places to go, better places, different options.  You know, trying to do watchful waiting is so hard.  I don't know if I recommend that.  You know, finding non-operative approaches is the way to go.  And whether that includes watchful waiting, seed implantation, external beam, radiation, and the promise of new drugs that will identify prostate cancer checkpoints, maybe some of the new monoclonal antibody therapies or the checkpoint inhibitors.  Hang on guys.  There's stuff coming down the pipeline that are going to make this whole prostate surgery look like medieval torture, even the robotic surgery, which has got a lot of praise, but really has about the same cure rate as a regular open prostatectomy.  Hang in there, guys, you'll be fine.  You can get through this.  There's lots of options and there's so much more available to you there than there was for me 20 years ago. 

Liz:      [25:22] As Dr. Peck points out, the industry is changing very rapidly.  It's crucial that patients do their best to empower themselves with the latest information. 

Dr. Peck:      [25:32] Well, Liz, it's been my pleasure and I hope that y'all who are listening will take heart and take heed and be wary and be brave. 

Liz:      [25:42] What do you think, Dr. Scholz?  We've got a man in his forties who had surgery, which leaves him impotent and incontinent, but doesn't cure his cancer.  He then tries Casodex , IMRT, and Lupron to control his cancer.  But all of these treatments leave him with more unwanted side effects, which then he has to go seek further treatment for.  His diagnosis was in 2001, which is almost 20 years ago. 

Dr. Scholz:      [26:08] Yeah, you know, in the last 20 years there've been so many advancements in the field of prostate cancer. Imaging and radiation have greatly improved, new medications are now available.  Despite this, I still see many patients come to see me in 2020 with a very similar story to Dr. Peck’s.  It's a shame to see so many frightened men falling back on our old ways now that we're in 2020. Urologists still control the prostate cancer world and surgery is still considered the gold standard in many circles.  The industry is changing and improving.  Better options are available.  The best thing patients can do is align themselves with an oncologist, like Dr. Peck did, who doesn't have a preset agenda of recommending one specific therapy.  Patients also must educate themselves and stay updated with the latest in prostate cancer. 

Liz:      [26:58] The more these intimate issues are discussed, the more people can benefit.  So we really appreciate Dr. Peck helping us give a voice to the silent disease.  Please help us out and keep spreading the word.  Remember to rate, review, and subscribe on Apple Podcasts.  You can send any comments or questions to [email protected].Dr. Peck:      [27:23] Yep, fellas, be your own advocate out there.

Discover the tests aging men can’t live without! Despite how common these diseases are, most men miss out on regular screening -- simple scans and screenings can save your life. Heart disease, cancer, and accidents are the top killers of men. Don’t miss out, take charge of your health and prolong your life.

IMPORTANT LINKS:

PCRI’s Men’s Health Checklist

Men’s Health Brochure

Dr. Scholz:  [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.  I’m your host, Dr. Mark Scholz.

Liz:  [00:09] And I'm your cohost, Liz Graves. 

Dr. Scholz:  [00:13] Welcome to the PROSTATE PROS podcast. 

Liz:  [00:19] Going to the doctor can be overwhelming and many men miss out on important tests. We're going to talk about a few tests men with prostate cancer should ask their doctors about while they're being monitored and treated for their prostate cancer. 

Dr. Scholz:  [00:34] Absolutely, Liz.  One thing I've learned after almost 30 years taking care of prostate patients, is that we're dealing with a slow motion situation.  What we've learned is that in this situation, other health problems, besides prostate cancer become more important and take on a greater priority.  What a tragedy, if someone who is in complete remission from their prostate cancer, all of a sudden develops a colon cancer that can't be cured.  This is a terrible development because men are in the doctor's office.  They can be screened for these things on a simple basis, whenever they come in for their prostate checkups. 

Liz:  [01:17] One thing I hear you talk to patients about all the time is getting checked for heart disease.  Heart attacks are the number one killer of men.  So this is a very important thing to be screened for. 

Dr. Scholz:  [01:27] Yes, indeed.  One thing that people don't know is that about a third of men discover that they have heart disease when they're dead.  This is a silent problem.  We're talking about the slow buildup of plaque in the coronary arteries to the point where an artery blocks off.  Now, many men, if they get to the hospital immediately, they will be saved because they can do a cardioversion and stents and all kinds of things like that.  But if they aren't taken care of in a timely fashion and they develop an arrhythmia, it's fatal.  The sad thing is that these things can be detected before a problem has developed.  This is when men can undergo a heart scan with a simple CT.  It takes five minutes to check if they have plaque accumulating in their coronary arteries.  This test is often covered by insurance, or if not, coverage costs maybe $200 to $300.  It only has to be done once every 10 years.  This test can help men detect this problem in advance.  Many people think that simple cholesterol tests are giving a clue as to whether or not there is a problem brewing that could turn into heart disease.  But cholesterol tests are very inaccurate.  Men with high levels may have no plaque at all.  Men with low cholesterol levels in theory should be protected, but they can have plaque.  So we advise that all of our patients get a heart scan to determine if they're at risk, because there are a number of things that can be done if a problem is detected.

Liz:  [03:06] Heart attacks are fatal and they're preventable, but why aren't men getting these things checked?  It seems pretty easy to get a coronary calcium scan. 

Dr. Scholz:  [03:16] I think what happens is that when people go to their family doctors, they've got some sort of an urgent problem and time is so limited.  The doctors are not looking to create new additional problems.  They just want to solve the problem at hand and move on.  This idea of looking for a problem that functions under the radar is an unattractive thing.  What if it leads to a need for some sort of an intervention?  People are frightened of those sorts of things, but this is one thing we're talking about, the number one cause of death in men, and it's preventable. 

Liz:  [03:53] Didn't our recent presidential candidate Bernie Sanders recently have some heart problems?  Does that mean that he wasn't screened? 

Dr. Scholz:  [04:01] Well, of course we don't know the inside scoop, but it seems very likely that that's the case.  Most of the time when people have a heart problem, it's because an artery was blocked off and this can be detected years in advance with these CT scans for coronary calcium scores.

Liz:  [04:23] This calls to attention that anybody can have heart issues.  So it's really important that patients ask their doctors about these tests.  Once they get their results back, it's really important to understand what they mean.  Can we talk a little bit about what cholesterol is? 

Dr. Scholz:  [04:39] So cholesterol is a fatty substance floating in the blood.  It's true that if it's elevated in the blood, that there's a greater risk of plaque being formed on the arterial walls, which is what can lead to a blockage.  So I think that the question here is: What do you do if you find this plaque, which is so common in men over age 40?  The answer is that simple cholesterol pills can stabilize or even reverse plaque.  It's a real shame for someone who's developing this progressive problem to not be on these modern medications.  Of course we can't minimize the impact of a good diet exercise and all the typical things, but statins can lower the risk of a coronary event by about 35%.  They're very potent. 

Liz:  [05:35] The other interesting thing about statins is a couple of studies have come out where they've shown actually lower mortality for men with prostate cancer. 

Dr. Scholz:  [05:44] Yes, this shows up in men with High-Risk prostate cancer.  So these are the men that come in with Gleason 8s, 9s, high PSAs, and they're treated with radiation and hormones hoping to be cured.  And many of them will be cured.  Interestingly, studies show that the men taking statins during this important time have about one third lower mortality rates than the men that are not taking statins. So again, simple medications, well tolerated are a very logical addition to your treatment armamentarium if you have High-Risk prostate cancer.

Liz:  [06:24] Another heart drug is baby aspirin. 

Dr. Scholz:  [06:28] It's been a little more controversial because some studies showed that if people with low risk for atherosclerosis and heart disease take baby aspirin, it doesn't really help much, but this study, which was in the media a lot in the last year or two, doesn't cover the fact that men that have significant plaque also have about a one-third lower risk of heart related mortality.  So it's very powerful and the people that need it and for our prostate cancer patients, the ones that have High-Risk disease, there's again, a significant reduction in mortality in men that are taking baby aspirin compared to the ones that aren't. 

Liz:  [07:06] And again, like statins baby aspirin can also have a positive effect on prostate cancer patients.  There was a study in the journal of clinical oncology that showed aspirin and proved the 10 year survival from 81% to 96%. 

Dr. Scholz:  [07:23] So heart disease is the number one thing on my radar when I'm talking to my healthy prostate cancer patients, the number two thing is colon cancer screening.  I've had a couple patients pass away from colon cancer.  These men actually had had colonoscopies and had been advised to have a colonoscopy every 10 years, which is a standard recommendation.  But these recommendations are merely a percentage, a projection as to what's a good balance between too many colonoscopies and the risk of colon cancer.  So both of these men had gotten colonoscopies about eight or nine years previously that were clear and then developed metastatic colon cancer.  This is a really sad development.  Of course they were trying to do it right.  We're bringing awareness for those of you that haven't had colon screening, you should all get colonoscopies.  And perhaps it needs to be a little bit more frequent than every 10 years just to protect against the outside chance of a bad disease developing in the interim.  Apart from that, there's a simpler test called Cologuard, a stool test that's done in your home, and then just the results are mailed in.  You can find out if you harbor an increased risk for colon cancer or early colon cancer.  So now we have two ways to check for this problem and make sure that you don't get blindsided by a preventable illness. 

Liz:  [08:51] Before we leave the topic of CAT scans for heart disease.  Can we talk about CAT scans for lung cancer? 

Dr. Scholz:  [08:58] Exactly.  The lung cancer mortality is even higher than prostate cancer mortality. Prostate cancer mortality is the number two cause of cancer death in men.  Lung cancer is the number one cause.  Of course this is related to either past or current smokers. I f someone quit smoking within the last 15 years, they're still at increased risk for lung cancer and should be getting an annual CT scan of the lungs.  This very simple five minute scan doesn't require any IVs.  Patients can be checking for any abnormal spots in their early developmental stages that can be cured if they're detected.  Of course, all current smokers should be getting a scan every year as well.  So this extends not only to our patients, but to their loved ones, their friends, their family, anyone that you know is smoking.  It's a loving and sensible thing to confront them and say, I know it's hard to quit and of course encourage them to do so, but if they can't, they should get a CT scan every year. 

Liz:  [10:07] What else should men be doing every year? 

Dr. Scholz:  [10:10] Well, our patients are pretty good about getting physicals every year.  And this of course includes a standard battery of blood and urine tests.  People ask me, what do we do a urine test for?  Basically, it's a screening test for bladder cancer.  You want to make sure there's no blood in the urine.  And that raises an interesting issue related to a new test called Cxbladder.  One of the standard treatments that urologists do for men with blood in the urine is a scope up the penis, which sounds uncomfortable, and I believe it is uncomfortable.  Now we have a new urine test, Cxbladder, that's very accurate for detecting bladder cancer.  So this is only performed in men that have traces of blood in their urine, but it's a great way to avoid getting a scope if you do have any blood in the urine.  Other annual tests are a skin exam to look for pigmented spots like melanoma, get your eyes checked once a year, make sure that the pressure in the eye isn't going up.  Glaucoma can cause a silent, progressive loss of vision, this is why everyone needs an eye check every year. 

Liz:  [11:20] Apart from getting a yearly physical, men also need to get vaccines. 

Dr. Scholz:  [11:25] One of the recent breakthroughs has been a new vaccination called SHINGRIX for shingles.  SHINGRIX is very effective at preventing shingles.  The lifetime risk for all of us that have been exposed to chickenpox, which is most of us, is one out of three people will get shingles.  Shingles is a nasty problem, but many people don't know that.  For the 10 to 15% of people that get it, it never goes, and they can be left with chronic lifelong pain.  So everyone needs to get the shingles vaccine that's been exposed to this had chickenpox at some time in their lifetime.  The other vaccines, flu vaccines, pneumonia, vaccines, I think are sensible.  I don't tout them with the same energy because we have a flu antibiotic called Tamiflu.  If you or a loved one develops flu symptoms, this is completely apart from this crazy COVID era that we're in, people can start on Tamiflu and their symptoms will usually go away within 24 hours. 

Liz:  [12:29] So we all know that women are a little bit better with preventative health than men are. And one thing that women are really aware of screening for is osteoporosis and osteoporosis also occurs in men. 

Dr. Scholz:  [12:42] It certainly does.  And we're more aware of it in the prostate world because sometimes our patients are getting hormone treatments that can accelerate osteoporosis. But the other thing is osteoporosis appears just as we get older.  This is all a part of aging that is losing muscle, losing bone.  This leads to greater frailty.  When you look at the things that take guys out, we've talked about cancer, we've talked about heart problems, but accidents, falls, hip fractures, these things are a big problem for our patients.  We have so many men that are in their eighties or even their nineties and something can be done about it.  Once again, we come back to the idea of scans, simple bone density scans can detect osteoporosis before a fracture occurs.  If fracture occurs in an elderly man, about 50% of these men will be put in a nursing home and it will be the end of their lives.  So tragic when a preventable problem like this, a simple injection, a pill, exercise, all these things can prevent this type of a disaster. 

Liz:  [13:57] To relate it to prostate cancer, hormone therapy accelerates calcium loss, which means a lot of those men are at extra risk for osteoporosis, but only 10% of these men are getting checked for osteoporosis. 

Dr. Scholz:  [14:12] Yeah, we've mentioned before that urology is supervising most of the prostate cancer in the United States.  These busy practices seeing 30, 40 men a day are administering Lupron shots, but men aren't getting checked to see if they're losing bone.  This podcast is to help you, men, know the checklist, what needs to be looked for not only for men on hormone therapy, but just because we're all getting older.  Prostate cancer is a condition of aging men.  You need to be aware of these important issues. 

Liz:  [14:48] So there are a lot of things men are missing out on during their doctor's appointments, heart disease, cancer, and osteoporosis are important things that need to be screened for.  As patients it means you need to be approaching your doctors and asking them for these tests.  To make it a little bit easier we created a list that we'll post at www.podcast.prostateoncology.com.  This is a really important episode to share because a lot of our listeners have prostate cancer. So they're probably aware of getting screened for heart disease and the risk of osteoporosis, but that's because they're coming into the doctor's office frequently and they have access to these tests.  So sharing this with people who aren't going into the doctor's office may really help them and it could even save their lives.  Please remember to rate, review, and subscribe on Apple Podcasts. 

IMPORTANT LINKS:

PCRI’s Men’s Health Checklist

Men’s Health Brochure

You may think COVID-19 and prostate cancer couldn’t possibly have anything in common. Yet, while prostate cancer and the novel coronavirus are clearly very different, some interesting similarities do exist. This episode addresses unique parallels between these two diseases.

Dr. Scholz:      [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls.  I'm your host, Dr. Mark Scholz. 

Liz:     [00:09] And I'm your cohost Liz Graves. 

Dr. Scholz:      [00:13] Welcome to the PROSTATE PROS podcast. 

Liz:      [00:18] For this episode, we thought it would be interesting to address some unique parallels between prostate cancer and COVID-19. 

Dr. Deborah Birx:      [00:28] But you have to predict on the data you have, which is heavily skewed to New York and New Jersey.

Dr. Anthony Fauci:      [00:34] Just getting back to that, that's really an important slide that Dr. Birx showed, the cluster of other cities that are not New York and not New Jersey.  If we can suppress that from any kind of a spike, the numbers could be significantly lower than what we're talking about.  There are really two to dynamic forces that are opposing each other here.  As I've mentioned several times in our briefings, the virus, if left to its own devices, will do that dark curve that Dr. Birx showed you.  The other dynamic force is what we are doing, what we're trying to do, and what we will do in the form of mitigation.  Now, these are very revealing bits of data.

Anne-Marie Green, CBS Anchor:      [01:18] Officials are going to have to convince people that it's imperative to get this vaccine if we want to contain this pandemic, but then they have to combat all this other misinformation that's out there.  Can we talk about that?

Dr. Neeta Ogden:      [1:30] Yeah, and I think you're absolutely right.  There's so much information. It's coming out every single day, just a real deluge of a lot of information.  If you're not even a doctor in the public health environment, it's almost too much to process.  So I think the big thing here is going to be once we do have a vaccine is to create a message that really conveys what we can expect this vaccine to do.

Dr. Scholz:      [01:56] Liz, thanks for taking up this topic.  I've struggled for years to try and explain to people what prostate cancer is.  We've come up with a five stage, different colors of blue to try and help people understand how diverse it is.  But people are always scratching their head and thinking that it's just one thing.  When COVID came along this year, it all of the sudden struck me that there are a lot of similarities and people are struggling to understand COVID, too.  I thought if we addressed this topic, maybe people would learn a little bit more about COVID and also a little bit more about prostate cancer. 

Liz:      [02:33] So one thing that we've talked about is both of these are kind of these umbrella terms that encompass a very broad spectrum of an illness. 

Dr. Scholz:      [02:43] We're all confused, you know, we've got one party saying that we should get back and this is a small thing and it's a bigger economic problem than a health problem.  We've got another group of people thinking that people are dying and we really need to hunker down in our homes.  We all know that there's truth to both sides.  It doesn't really allow for a one-size-fits-all mentality.  So there's got to be some distinction.  Of course people are starting to do that by breaking down who gets sick and what kind of sicknesses people have. 

Liz:      [03:18] So it's just like prostate cancer because some people need treatment and some people don't need treatment at all. 

Dr. Scholz:      [03:25] Exactly.  So we're hearing that as many as a third of people that catch COVID don't even know that they have it.  Then at the other extreme, if this horrible disease gets into a nursing home up to a third of the people ended up dying from it.  So we have a spectrum of completely harmless, as we've seen with prostate cancer many times with the Low-Risk form, up to people dying.  And the statistics with prostate cancer are that 25 to 30,000 people die of prostate cancer every year. 

Liz:      [03:56] So one major thing they both have in common is fear. 

Dr. Scholz:      [04:00] Boy does it.  People when they come see me for the first time for their prostate cancer, I have over and over seen people literally trembling in fear.  The thing we do of course is we try and share information, accurate, trustworthy information.  Thankfully with prostate cancer, almost always the news is really good and people are able to calm down when they get the facts.  And this COVID situation has been so challenging because no one had the facts.  This was a giant mystery that came out of the blue this year.  Now as the facts are trickling in and we're finding out that certain people are susceptible, others are not, you can actually feel the fear level going down.  I remember the first days of this, going to the market and seeing the lines outside waiting to get into the grocery store and just the paralytic frightening spirit that was hanging over these people.  Now you still can sense that, everyone's wearing masks, but people are starting to loosen up a little bit.  This is because we're starting to understand what the problem is. 

Liz:      [05:12] Knowledge counteracts fear.  And that's something we're trying to do with this podcast.  There have been studies that show that after a prostate cancer diagnosis, the risk of suicide and heart attacks both increased drastically.  We think that with accurate knowledge, we can decrease this, which is one of the reasons why we're making this podcast. 

Dr. Scholz:      [05:35] Yeah.  You know, it's terrible to understand that we're hearing from the hospitals that the number of people coming into the emergency room with strokes and heart attacks has dropped off dramatically because people are so afraid that they've lost perspective on what's really dangerous.  They're staying home with their chest pain and their strokes because they're afraid of catching a virus.  This is a perfect example of how fear can distort thinking.  We see this all the time in the prostate cancer world where people come in and they're making foolish choices because they have so much fear. 

Liz:      [06:13] Have you had a lot of patients canceling appointments because of fear of COVID? 

Dr. Scholz:      [06:19] We have indeed.  Fortunately, most of our prostate cancer patients are on a very slow type of a pathway and postponing a visit for a month or two doesn't really harm them in any way.  But yes, we can sort of judge the fear factor out there by how many people are willing to come into the office. 

Liz:      [06:40] So as we've talked about, fear can force men into this overaggressive, unnecessary treatment.  Now that COVID is happening, some men will find they have some time to slow down and do research and it might actually be a good opportunity for them to delay treatment. 

Dr. Scholz:      [06:59] Yeah, that's always been a counterintuitive thing in the prostate cancer world, where you have something called cancer that doesn't need immediate treatment. 

Liz:      [07:08] So another interesting parallel is the demographics that affect both COVID and prostate cancer patients. 

Dr. Scholz:      [07:15] Yeah. When we talk about the people that get ill from COVID, it turns out that it's the same as our prostate cancer population.  We're talking about elderly men.  Now interestingly, there is also an issue with being overweight.  The people who are overweight do worse with COVID and they also do worse with prostate cancer.  So weight control is a critical thing for health and both of these conditions are bringing that message home in a strong way. 

Liz:      [07:45] So how do you lose weight, Dr. Scholz? 

Dr. Scholz:      [07:48] So this is always a sensitive subject because we don't want to deal with the pleasure aspects of our lives.  But I have been counseling patients who are really motivated to lose weight, to do something fairly simple; that is one less meal a day.  That seems to help people get some clarity on how they can change their daily behavior and make progress in this area. 

Liz:      [08:13] So eating less is a recommendation.  Is there a type of diet? 

Dr. Scholz:      [08:17] Yeah, our average American diet, which has a lot of protein and fat in it, has a lot of calories associated with it.  So if people can switch over to a more vegetarian type approach, the caloric density of this food is a lot less and people are able to eat more food without getting as many calories. So you can see I've sort of been focusing more on weight loss than what people are actually eating. Studies have shown that vegetarian diets are better for prostate cancer patients. However, any diet that leads to weight loss is a good thing. 

Liz:      [08:50] So diet needs to be personalized to the individual.  So it's smart to talk to your doctor before starting anything new or even seeking the advice of a dietician.  Another common thing for weight loss is exercising. How often should men be exercising? 

Dr. Scholz:      [09:06] So this subject comes up frequently because many men with prostate cancer have to take Testosterone Inactivating Pharmaceuticals that lower their testosterone levels and cause loss of muscle and potential weight gain.  The most direct action to counteract that is weight training or what we call resistance training to keep the muscles built up.  Muscle tissue is high metabolic tissue so it consumes more calories during the day, 24 hours a day.  Larger muscles increase your metabolic rate. Weight training is the most direct way to help burn calories. 

Liz:      [09:42] So when you're focusing on your change in diet, you can try a different diet. You can try maybe skipping a meal a day and you should definitely be exercising.  Now, Dr. Scholz, you just mentioned TIP and there's actually been a little bit in the news lately with COVID-19 and TIP. 

Dr. Scholz:      [10:00] Yeah, the Prostate Cancer Foundation recently did some epidemiologic studies in Italy where we know there was a huge hit with so many people getting sick over there.  They looked at men who are taking TIP or hormone therapy and compared their incidence of catching COVID and the incidence of dying of COVID.  Of course many people were concerned, and in fact I've gotten questions, “Dr. Scholz, will taking TIP make me more susceptible, will it weaken my immune system?” It turned out to be just the opposite.  The incidence of catching COVID was four times less common compared to the men in the similar age groups that weren't taking TIP and the mortality rate was four to five times lower for men that were taking TIP.  There was some underlying scientific guesses as to what this is due to, but of course nothing has been confirmed yet. We do know that men are more susceptible to dying from COVID than women are.  Is this somehow connected to testosterone?  We don't know yet, but the good news is that for men who are taking treatment for their prostate cancer, they don't need to be concerned that they're taking a chance or becoming more vulnerable to COVID. 

Liz:      [11:17] If you're curious to learn more about hormone therapy, listen to our episode Hormone Therapy TIPs.  We'll keep you informed as more information develops on this.  So, Dr. Scholz, as we know with prostate cancer and COVID-19, there is a ton of information out there.  What are you supposed to do with it all?  How do you find what's right and what's wrong? 

Dr. Scholz:      [11:40] Boy, it is challenging and it is a giant headache for our newly diagnosed prostate cancer patients.  They come in with notes and books, they've been looking at YouTube and it's just endless.  The frustrating thing is that a lot of the information is not that accurate.  So how do you sort it out?  I don't have a simple answer to that.  There is a resource in support groups.  Of course the PCRI is offering online information for patients.  Seeking centers of excellence is going to be really helpful.  The problem is that people have conflicts of interest.  There are things going on in the background as we've seen with this crazy back and forth on hydroxychloroquine.  It's been politicized and that seems dreadful because people's lives are at stake.  But how well does it actually work?  Well, it seems like it might be beneficial, but it has not yet been proven to be so it is very controversial.  This is exactly what we struggle with in the prostate cancer world: tons of information and some of it not very accurate. 

Liz:      [12:56] One good way to sort through the information on prostate cancer is to take the staging quiz at keytopc.com. 

Dr. Scholz:      [13:06] Yes. That will help you find out what type of prostate cancer you have and give you a better idea of what you need to be researching. 

Liz:      [13:15] Okay, so far we've covered a lot of the similarities, but most of us know that COVID and prostate cancer are quite different. 

Dr. Scholz:      [13:23] Yeah. I think the biggest discrepancy is how COVID is an infection.  It surfaces within five to seven days of being infected and runs a course of two to three weeks and then hopefully you have lifelong immunity.  Prostate cancer is something that develops over a period of 10 to 30 years.  That is hard to wrap your mind around because decisions today could have an impact 10 to 20 years from now, but we don't even know if the technology will be the same in 10 to 20 years.  Maybe something that's deadly today will be treatable in 10 to 20 years.  COVID is similar in that there's a lot of mystery about what the right thing to do is.  There still is mystery about what to do with prostate cancer, but the natural history, the time over which it has played out, goes for such a long time with prostate cancer. 

Liz:      [14:16] So you just mentioned how prostate cancer patients can live for years with their diagnosis. One interesting thing is that a lot of people have prostate cancer and they never even know it. That kind of parallels how people with COVID can be asymptomatic, which means they're walking around with it, but it's not affecting them at all. 

Dr. Scholz:      [14:35] What we call asymptomatic forms of disease in this modern era is becoming more of the standard.  In the old days people didn't show up to the doctor unless they were hurting.  But now we have tests and we can even detect these asymptomatic forms of disease.  This is such a contrast and brings it back to this very confusing fact that when someone says the word COVID, one person thinks harmless and another person thinks deadly.  This is exactly what we confront with prostate cancer as well.  One person will say it's no big deal, and another person will say, my uncle died of it.  This sort of confusion can only be counteracted by better knowledge and by spending some time researching your options. 

Liz:      [15:24] We're really excited to keep you up on the latest in prostate cancer.  Thank you for listening.  You can email any questions or topics to [email protected] and remember to help us out by rating, reviewing, and subscribing on Apple Podcasts.