Prostate Cancer and COVID-19

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.