So, Dr. Scholz, one of the things I want to talk about is stress. This happens to everyone,
but when you're in a cancer situation, the stress gets higher and it affects the family.
So, can it cause prostate cancer? What is the effect of stress on prostate cancer? What
does that look like?
Well, it's an interesting subject because we all face it, and the fact that some patients
that I see who have come down with cancers are convinced that the stress that they had
leading up to that diagnosis was an important cause is very real. People go through extended
problems with the loss of loved ones or jobs where this drags on for a year or so and then
people are diagnosed with a cancer, they obviously make a connection there. It's hard to scientifically
study the question because what really is stress? How do you measure it? And there is
evidence, of course, that people under constant stress run higher cortisone levels in the
blood, and it's well known that if you give people pharmacologic doses of cortisone that
you surpress their immune system. So, there's a basis towards thinking there's a physiologic
connection between stress and suppression of the immune system which, of course, can
lead to different types of cancers. So, we can speculate about it and talk about it.
The actual proof that there's this tight connection between stress and cancer doesn't really exist,
but it's still reasonable to talk about how stress functions in our day-to-day lives and
what is an appropriate attitude towards stress because, obviously, we're not going to be
able to escape stress. Stress is going to occur on and off throughout our lives and
I think that the magical aspect of dealing with stress has to do with that on and off
type of thinking.
What I really think is dangerous stress is continuous unremitting stress where the body
never gets a break and doesn't have a chance to rebuild and rest and recuperate. The whole
idea of the Judeo-Christian thinking is to work hard for six days and then have a down
day and let everything recuperate. So, the idea of intermittent stress is what we do
like when we go to the gym and vigorously work out or people want to run a 10K or do
something that stresses them out physically and then if they have a time to recover and
relax, their body rebuilds and then they go back do it again and they're stronger. So,
stress can actually make us stronger if it's on an intermittent basis. So, when we talk
about the negative aspects of stress I think we're mostly talking about continuous unremitting
stress and sometimes life circumstances, with the difficulties it presents, put us in a
position where we don't get that down time, and I think it is dangerous. I don't think
it's just cancer; it's heart disease; it's other chronic illnesses which we see manifested
in irritable bowel syndrome and asthma and people who get rashes and all these sorts
of things many times are rooted in continuous stress. So, we shouldn't really talk about
stress itself as being a negative thing. It's continuous stress that is, indeed, a very
negative thing, and how we figure out how to take a break, to be able to get some downtime
and allow everything to recuperate is part of how we learn how to live life successfully,
and it's a challenge for all of us and we're always learning.
So, when you see patients that you sense they're very stressed in your office, is there any
advice you give them? Like exercise, meditation, talking to a counselor or a family member?
All of the above. The idea of dealing with anxiety and fear in the office is very much
on the top of our agenda. People who are stressed out and frightened don't think clearly. They
tend to make foolish decisions, they tend to jump into things that if they had reflected
further they probably wouldn't have done. So, it's always a high priority to try and
get people to calm down and the best way, I think, is by finding out the facts. When
people feel like their feet are more on firm ground, they're able to get their bearings
and understand what to do; what are some action points they can take. Oftentimes, fear and
anxiety is based in the unknown and "where's the next lightning bolt going to come from?"
So, we try and educate patients and help put their prostate cancer status in a perspective
and once they have that perspective a lot of times people calm down a lot.
I think that goes back to one of the hardcore tenant beliefs of PCRI where we think you
should really have a trusted source for prostate cancer as a doctor, and if you have somebody
who's giving you anxiety or you just don't think that they know what they should know,
it's important to get somebody who is thinking clearly, knows the subject, and can treat
you with that mindset.
Yeah, and as patients study up on prostate cancer, they're able to evaluate the knowledge
level of their physicians, and it's very comforting when you come in with fresh idea to your doctor
and he's already aware of that and he's prepared to explain whether that does or does not fit
your particular treatment protocol, and then when people give you a blank look and are
unfamiliar with some of the later treatments, obviously that doesn't generate confidence.
How do you see stress affecting diet in prostate cancer patients? Do you think that maybe stress
can cause them to overeat or undereat and maybe even that can cause issues?
Well, I'm not really an expert in weight control and that sort of thing. I know it's a huge
area, and of course, you would think, yes, people under greater stress look for pleasure
and ways to try and escape from the discomfort of the anxiety and overeat. I suspect that
is probably true. But the whole idea of how to achieve successful weight control, boy,
that's a deep subject.
Right, so I know we talk about prostate cancer and exercise. I think I've heard a lot of
patients go on these exercise regimens and they're able to think clearer, their endorphins
are rushing, the stress levels are going down. So, do you have every patient in your prostate
cancer practice exercise? Is that your suggestion to them?
Yes, actually. Most of the people that we see are over 50, 60, 70 years old and we know
that as people get older they lose a little bit of muscle every year, and that eventually
translates into someone getting old and weak and unstable on their feet. So, as a preventative
measure, we try and get all of our patients doing resistance training to build up their
muscles.
Thank you.
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