Hi, I'm Dr. Scholz. Let's talk about... Men's health.
We've been covering prostate cancer now in an extended series, and it's probably becoming
clear now that prostate cancer is more like a chronic condition than an actual cancer.
Many serious cancers can be deadly within months of diagnosis. I was seeing a new patient
yesterday with a Teal stage prostate cancer—a 60-year-old man—and he was quite nervous
about his diagnosis and we had gone through a lot of different issues, and he said, "Bottom-line
Dr. Scholz. What's my chance of dying?" And I said, "I estimate that the risk of mortality
for his Teal stage prostate cancer maybe 1% at 10 years." He practically fell out of his
chair. He thought that he was facing imminent mortality with his prostate cancer.
And that's really the root basis of this discussion today, talking about the annual physical exam
which takes on added importance if you're going to live a long time. What a shame to
beat prostate cancer and end up succumbing to some other condition that was preventable.
I find patients are often confused about what an annual physical exam consists of. They
talk about a panel of blood tests like its a standardized format, and it's not. It may
simply be a couple tests of your liver and kidneys or it may be a much more extensive
test that covers vitamins and function of your red count, and we're going to post an
actual list of the types of blood tests that should be included in your annual physical
so that you can do a checklist and find out if all the important things are being covered.
Apart from those components, the blood tests and the urine tests, that should all be done
once a year, there's some other things that should be looked into to make sure that a
preventable illness doesn't cause you to die of something that you could have fixed. So
let me quickly list some of the things that we check in our patients to make sure that
they don't die of heart disease or a preventable cancer.
First, a CT scan for coronary artery calcium score. This is a 3-minute scan; it doesn't
involve any injections or IV's, and they can monitor whether there is plaque forming on
the coronary arteries. Doctors can use this information to decide if you need a cholesterol
pill, whether you need any interventions to prevent heart disease. I recommend this every
five years, 5-7 years in our patients.
What about smokers? Men who smoke tobacco are obviously at risk of lung cancer. If lung
cancer is diagnosed after it spreads, there's really no way to cure it. But the CT scans
of the chest, done on an annual basis in smokers, can detect lung cancers at a curable stage:
when they're small nodules. Everyone who smokes—if you have a family member who smokes—needs
to be encouraged to get a CT scan of the lungs once a year.
Colon cancer is another preventable cause. Historically, people have undergone scopes
every 10 years. There is a new test out now called Cologuard, a stool test that can be
done every three years which can detect colon cancer as well, and that's a far easier test
than going through a whole scoping procedure.
A subject that's come up in our prostate cancer patients who go on hormone therapy is loss
of calcium from the bones called osteoporosis. If that becomes notable people can develop
hip fractures and those are preventable with a variety of different medications. A simple
scan, once again, of the hip with either a DEXA scan or a QCT can detect this at an early
stage. The problem with these things that we're describing is that they all tend to
be free of symptoms until something is broken or something is irreversible. This is the
point of the annual physical exam: To screen for preventable things when everything seems
fine to make sure that something doesn't sneak up on you.
Two last things that I want to mention. One is a new vaccination for shingles. Shingles
will occur in one out of three of us in our lifetimes. It's a nasty condition, but what
people don't know is that about 10% of the time, it never goes away. You can be left
with life long pain and this is preventable with a new vaccine called Shingrix. It's a
two-part vaccine. You can pick it up at the pharmacy. Just go in and say, "I want a vaccine."
You don't even need a prescription from your doctor.
The last thing that can be overlooked is an annual eye examination. People who wear glasses
or contacts are forced into doing this and that's great, but those of us that aren't
seeing an eye doctor regularly still need to go in for an annual visit. Why? A condition
called glaucoma which is a silent increase in ocular pressure that, if it goes undetected,
it can cause irreversible loss of vision without you knowing its occurring. So everyone should
get an annual eye check whether you are seeing the doctor for eyeglasses or contacts or not.
One last thing that shouldn't be overlooked during the annual physical is to have the
physician check your skin. Look on the soles of your feet; look on your back; you can even
ask your family members to do this. Especially here in southern California where we get a
lot of sun exposure. Dark pigmented lesions need to be vigilantly watched and possibly
biopsied. The concern, of course, is melanoma. Melanoma is not that common, but if it spreads
we don't have any way to cure it. It can be cured if it's detected at an early stage.
So this summarizes what we consider the annual physical exam which is important for our prostate
cancer patients because they're going to live a long time. We did a whole webinar that went
into greater detail that is posted on our Youtube channel if you want to look into this
further.
Thanks for watching. Subscribe to our Youtube channel for more of these videos and visit
our website which has a wealth of information about prostate cancer.