Prostate Cancer, but What Else?

Prostate Cancer, but What Else?

 
 
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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

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