Video: Does Stress Cause Prostate Cancer? | Ask a Prostate Cancer Expert, Mark Scholz, MD
Ask a Prostate Expert | Transcription
Alex: 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?
Dr. Scholz: 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 suppress 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 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 downtime, 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.
Alex: 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?
Dr. Scholz: 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.
Alex: 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.
Dr. Scholz: 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 ideas 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.
Alex: How do you see stress affecting diet in prostate cancer patients? Do you think that maybe stress can cause them to overeat or under eat and maybe even that can cause issues?
Dr. Scholz: 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.
Alex: 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?
Dr. Scholz: 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.
Alex: Thank you.