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Coronavirus Precautions for Prostate Cancer Patients

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Published on March 31, 2020

Key Takeaways

  • Co-morbidities like cardiovascular issues, diabetes and COPD increase the risk of having complications from coronavirus.
  • Bone marrow toxicities from radiation can impact white blood cells and lymphocyte count, which are important for fighting infections.
  • Having someone deliver groceries to your home and doing telehealth visits are ways to reduce your risk of exposure.

Though research is still emerging, it’s evident that while anyone can get infected, the elderly, immunocompromised and those with underlying health conditions are more at risk for serious complications from coronavirus. What are the risks for people living with prostate cancer? What precautions should patients take?

During this Ask the Expert program, Dr. Eleni Efstathiou, from The University of Texas MD Anderson Cancer Center, answers questions from patients and care partners about coronavirus and describes the impact of the outbreak on prostate cancer care.

Watch as Dr. Efstathiou discusses treatment plans, some toxicities and co-morbidities associated with immunocompromise, and discussions to have with your doctor.  

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Transcript | Coronavirus Precautions for Prostate Cancer Patients

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded March 27, 2020

Andrew Schorr:
Greetings, it's Andrew Schorr from Patient Power down in Southern California, and this is our live prostate cancer Ask the Expert program specifically talking about issues related to coronavirus and the COVID-19 disease as it affects people living with prostate cancer. And we have a noted expert from the MD Anderson Cancer Center in Houston, one of the top cancer centers in the world. I'm going to introduce her as Dr. E, but I'm going to let her pronounce her whole name and her area of expertise at MD Anderson. Dr. E, welcome to the program.

Dr. Efstathiou:
Andrew, thank you for having me. And it's such a pleasure to be able, in real time, to share information with all our patients. I'm actually—I was rushing over to come home to actually just make the stronger point to stay at home to all of us, come to really understand how we're even doing it at MD Anderson when we don't have clinical work there, we're all being asked to work from home to do things that can actually help alleviate the pressure in our clinics, in our emergency rooms right now.
 
So, hello from Houston, Texas. I'm Eleni Efstathiou. I'm a medical oncologist, I've been very privileged to focus on the treatment of prostate cancer throughout all my career. And we're living through new challenges, and I think there's always a silver lining, we're going to learn new things, and we need to keep on being positive. So let's get to it.

Andrew Schorr:
Okay. Dr. E, so we have a number of questions, and that's why we're doing a cancer specific program. And Patient Power is doing this in many different cancers. I'm a leukemia patient, and so some situations relate to me. But now we're talking about prostate cancer as a solid tumor. So first of all, just somebody with a 
diagnosis of prostate cancerdoes that put them at higher risk of getting the coronavirus?

Dr. Efstathiou:
Let me, first of all, congratulate you for all your efforts. I had the opportunity to watch wonderful videos, very informative, and, of course, commend you all for doing all this for the whole community. And here it is. Let me get to prostate cancer. You know, as a man, it's the most common solid tumor, right? And there are tiers of prostate cancer, right? There's a huge spectrum. So from something that we all call a want-to-be prostate cancer, never amounts to anything, all the way to a very aggressive form. That, thankfully, is rare. We don't have it as commonly as you see in other cases, well, leukemia and the like. So this is the one thing.
 
When you say prostate cancer, huge spectrum, or history of prostate cancer. So let's take it as a matter of risk. We should err on the side of caution. We should take every patient with cancer, if it is active, as a potentially compromised patient. Yes, however, there's a special nature to prostate cancer. It afflicts men, it afflicts older men, median age of 65, we all know it, and the more advanced, usually you see older men. And these men, because of the treatment that we give them and because of their age and other factors, have all these co-morbidities that have been associated with this compromise, this vulnerable, I would say an even frail group. We need to really babysit our prostate cancer patients, not because so much of the prostate cancer but because of everything that comes with it. And we can go more into detail. That is the risk.
 
My everyday patient, I've been calling every day 20, 30 patients telling them, "Stay home, stay home, do this, do that." They're 70, 75, 80, 85. They have hypertension, they're a little bit chubby. There's the obesity factor, we know about it, and they're males. And I'm sure you have discussed how we've seen more of events happening in the male population rather than the female, which we need to understand better.

Andrew Schorr:
Right. Okay. So, an older man may be more likely to have cardiovascular issues, diabetes, and there does seem to be, with the virus, if you develop it, more even severe complications, not just with your lungs but with your cardiovascular system, right?

Dr. Efstathiou:
Absolutely. We're learning every day something new. As patients are sitting at home listening to this and say, "Hey, I need information." I can tell you; people see the white coat in the car, and they roll down their windows and ask me questions. And we don't have answers. It is really a very, as I said, you learn through this experience how we have been—we're usually ready to give an answer. Doctors, we believe, we usually act like little gods sometimes, which is wrong, but this is a very, very humbling moment where we don't know. And we can use these associations.

And as you said, a man who is over 60 years old, sometimes even over 50, with extra weight that will lead to the lungs sometimes being more restricted, some cardiovascular history, hypertension even, if it is, doesn't have to be a heart attack, it can be hypertension, a history, let's say, of COPD, definitely the diabetes that we know are immunocompromising. Boom, you have already all these co-morbidities that add to the risk of a very serious infection that you cannot take any chances with.
 
So, you are 100 percent correct, and as you said, the virus does not only hit the lungs. It can hit the heart. We've had some unfortunate episode of what we call myocarditis, the muscle, the heart is being hit. It can actually also cause some neurological symptoms we've seen, and we haven't really explained all that. So yes, you can even have some GI developing symptoms—smaller percentages, but we have to be able to prevent all of that from happening.

Andrew Schorr:
Okay. Dr. E, and for the audience, I'll just mention, folks, if you're with us now, and many people are, certainly you've sent in questions, which I have a list here that were sent to comments@patientpower.info. But right now, with the little button at the very bottom of the screen, Q&A. You can hit that button, it'll send a question to our producer, who happens to be my wife, Esther Schorr, and she will be sending these to me as well.
 
Okay. So now we talked about risk and risk of complications, and someone's personal situation, age that could affect that. Okay, so you have prostate cancer patients who have had or are having radiation, or they're on maybe an advanced prostate cancer medicine. So, maybe you could talk about those. Many men get radiation, and many men have various pretty powerful therapies for advanced prostate cancer. Does that yet increase their risk?

Dr. Efstathiou:
Excellent question. The answer is we do not know. We do not have the data. I actually watched your previous webcast with some of our colleagues from other fields, and we're all saying the same thing. The only published piece of information is coming from 18 patients, 18 patients that we don't know of, because they're trying to get the data to us quickly, but it's not granular. We're not understanding. Did they have active cancers? They didn't look like they did, some of them. Some did have active cancers. We don't know about radiation and the like.
 
What we do know is if you have a man who is on a radiation of the pelvis because of the prostate being radiated, the chances of immunocompromise are small by that sheer event of radiation, unless you are radiating a big part of your bone marrow where bone marrow is where our blood is being produced for our patients, and, of course, white blood cells may be afflicted. And, of course, you may have less of those lymphocytes that are important for the 
immunity against the virus as well as with a lot of other things. But we monitor for that, right? We do tests for that. And with modern technology, we have managed to move away from that event.
 
So, I'm not as concerned about radiation as I would be with, let's say, a very strong chemotherapy. When it comes to that, thankfully in prostate cancer we have less use of chemotherapies. We use more these hormones, these new actual antigen signaling inhibitors. These are not as compromising—not as compromising.
 
Chemotherapies are a challenge, because, even though they're not like the chemotherapies you use in leukemia, these are older men, so they may be more compromised. So we have to pay extra attention these days when giving chemotherapy. I'll give you an example. I have this older gentleman, he's about 80 years old. He has a disease that is quite aggressive, unfortunately. He needs the chemotherapy. I don't have the time to wait until this all goes away. But he lived in Louisiana. Thankfully his daughter is with us at MD Anderson. He can stay in Houston. We saw the numbers go up in Louisiana, "I'm telling you, for me to do this, I need to ask of you to stay here. Stay put. Be close so I can potentially try to give this to you." And he agreed.
 
So, it has to be—you have to weigh what we call the therapeutic index. What is the risk given COVID now? What is the expectation? In a lot of countries, I was just speaking to our colleagues in Saudi Arabia, United Emirates, all these areas where they don't have our structures, they have shut down all chemos, which is devastating for a patient. Here we are, have the ability to at least support our patients as best as we can still.

Andrew Schorr:
Okay. So, Dr. E, it sounds like then it's an individual discussion between the patient, the family and the doctor about if you're in active therapy, is it deferred? I'm talking about the infused therapy right now. Do you come to the clinic? Do you need a scan or a blood test? What do we need to do now? And it's winging that the advancement of the disease or trying to hold that versus risk of the virus. Is that right?

Dr. Efstathiou:
Correct. Can you see me okay? I lost you for a minute.

Andrew Schorr:
Yeah. Yeah.

Dr. Efstathiou:
So absolutely. What is extremely important, extremely important in this situation is to really have this, and a lot of it will be like we're doing with video or with a telephone call, because we don't want to expose you to us in the hospitals, in the clinics. We don't want to take risks with you, the patients with us. And when we say we need to hold it is because we're taking into account what you said.

What is the extent of the disease? How well is it controlled? And what is the risk if you get compromised with chemo, and you get exposed to that virus? Which we know 
spreads rather fast. And then if you get it, the more compromised you are as we said, the more the chances rise. And they rise over 30 percent, 40 percent to get a serious, serious viral infection. So we need to really allow the physicians and that patient-by-patient case to have this discussion, physicians and their providers, of course.

Andrew Schorr:
Okay. Let's role-play for a minute. If I were one of your patients with let's say more advanced prostate cancer, you or your nurse, your clinic might be calling me. Let's say if I were supposed to have a procedure or scheduled follow-up visit or blood tests, you would call me before and say, "Let's talk about how you're doing and whether you need to come in. Or if I want you to get a blood test, maybe there's a clinic I'm going to send you to right near your house if we need to. Or maybe I know we're trying to work on the home healthcare. Can a nurse come that's safe?" So you ask all of these things, but that might be a phone call or a video hookup like this. Okay. If I come in, the hospital is doing everything it can to protect you as the provider and me as the patient. right?

Dr. Efstathiou:
Absolutely.

Andrew Schorr:
Now let's go on for a minute about oral therapies, of which there are oral therapies for prostate cancer. What about that? Is there any reason, because of this virus, for someone to stop treatment, change dosage, anything because of the virus?

Dr. Efstathiou:
Excellent question. For now, we can clearly say that because of the virus, and we're speaking mainly to those hormone pills that are available for prostate cancer, there are four different types right now, four different brands out there, and there's even a generic form. So these drugs for now should be continued as has been requested by the physician. Having said that, usually we call the patient to come in every month or every two months to be seen and be assessed for toxicity. Now it's going to change a little bit, because we may not be able to do that.
 
So, what happens in this case is obviously we have to immediately have this video conference or teleconference with the team and discuss with them, "Should I continue as I am?" And, of course, in that case what happens is the team will give you the right dosing. Some of these drugs cause fatigue. Some of these drugs cause hypertension. Some of these cause low potassium. All of these factors need to be keyed in when the physician decides if you're going to be put on a hold.
 
Let's say, Andrew, you were my patient. You had been on these treatments and your disease was controlled for years, which can be the case, right? And then you call me and you're like, "Dr. E, I'm not feeling very comfortable. I feel a little tired now." I have a lot of patients who say that. I say, "Okay, let's take a break. Let's take a break for a month." It's fine. It's fine if the disease is controlled. If it is not, of course your physician will try to adjust the dosing. We'll try to do what you described, do some remote labs, call you. We are learning new ways of assessing our patients, having the imaging done locally. This is a good opportunity to explore what technology will bring to us. There's nothing like a face to face or touching your hand, really reinforcing my thoughts, sharing moments with a patient. But we have to get through this.

Andrew Schorr:
Dr. E, you're at one of the major cancer research centers in the world, MD Anderson, and some of your patients are on clinical trials. The FDA has been changing, relaxing some policies related to trials, because you have people who come to see you from all over the world. Like Saudi Arabian oil sheiks come to MD Anderson. So my question is if you have someone in a clinical trial, are there procedures changing where some of the work can be done maybe through you as an investigator at a clinic near them?

Dr. Efstathiou:
Absolutely. Before even the FDA published and gave us all these instructions that it was two-and-a-half weeks ago, a number of investigators who do a lot of the clinical trials, and I also have the privilege of serving our institutional review board, we got together about 10 of us and put together some guidelines in anticipation precisely of this. Having said that, we cannot expect that we can start these trials and put patients on trials with drugs that have not been yet at least tested initially, right?
 
So, I can give you an example. Out of 50 trials of my department, which is the genitourinary department, is running right now. Only four have remained open to new patients. And these are the four that have the type of oral drugs that we described. We know how these drugs perform. You cannot take chances right now with drugs that are just new out of the box, out of their first trials in animals. You cannot do that. There is no reason to take such risks. But the FDA has allowed us to continue with those where we know the toxicity, we know what to expect and has, as you said, relaxed the rules so patients can actually have some of these medications in special circumstances shipped to their home, and they can have some local labs, and they can have this interaction like we're doing right now with their physician.
 
But it becomes now more of a responsibility between the patient and the physician like myself. We have all this research stuff that is supporting us. Do you know that nobody of these research people can get into MD Anderson right now? They're not allowed, because we're protecting our patients. So it all falls upon us, the physicians and you the patients, to interact in a way that's very direct. I'll give you an example. Not everyone has to do it. All my patients have my cell phone. They had it already, but now they're actually using it, which is great. This is the time.

Andrew Schorr:
Dr. E, I understand about the trials that are going forward where you're accepting new patients, but you have patients, and we have some who were asking questions about, "I'm in mid-trial."

Dr. Efstathiou:
These trials are continuing. Absolutely. They are not being held. But if you can do it in a local facility with safety, you will do it. However, if you are in the middle of a trial that is extremely high probability of toxicity, what your physician most likely will do, they'll probably judge it again like we do with clinical practice. What is the expectation? What is the risk? If the risk of toxicity, taking into account the COVID component now, overcomes the expectation of efficacy, they will try to defer it. They will try to hold it. That is the right thing to do.
 
Andrew, I know you share with all the patients out there how right now everyone's feeling very stressed, especially when you have cancer and you worry that we're all turning towards the COVID ,and we're leaving behind a little bit our cancer patients. You can't help but think that, right? That is not the case. We are all continuing as much as we want and try from home or in MD Anderson to just get this under control so that we can move on with our research against cancer as we did before. That is why this flatten the curve becomes so important, so we can get back to where we were as soon as possible. And I know it's a lot to ask from everyone, but the patients should know that this is all being done for them, and that is why we're holding. We cannot afford to lose our patients to this virus. I make this joke sometimes and say, "I did not try all these years so hard to keep you around to get the stupid virus to take you from me." Patients understand. All of my patients understand that.

Andrew Schorr:
Well said. I just want to recap then a couple of things here. So if we, and my father passed away from advanced prostate cancer, so it's very real to me and so many families. If we stay home, do handwashing, all the things we're talking about to 
lower our risk of developing the virus, can stay far away from the hospital with symptoms of the COVID- 19 disease, that allows you and the whole medical team to do all the other things, including moving research forward, right?

Dr. Efstathiou:
That's 100 percent. You're giving us the time to focus on this. Right now at MD Anderson, we are privileged to be learning from what is happening in New York, because it hasn't hit us, and it will, and we'll hope not as much. We have three patients only. But I speak to my colleagues for over in New York, and you have seen what is going on. Right now, all efforts are turned, because they're overwhelmed towards the COVID virus, so we need to help alleviate them. I'm happy to take care of their patients to come to me as their other community practitioners so that we can all, all these premier centers that are over there, can get back to what we do best. You're right. Let's try to control this and not overwhelm our healthcare system so that we can bounce back and be even stronger next time, ready for this.

Andrew Schorr:
Doctor, as you know, given the age of many prostate cancer patients, unfortunately, men living with even advanced prostate cancer now longer than ever before because of the work of you and your colleagues around the world, and I know people like that. They may be alone. It could be Grandpa who lives alone, and so now you're thinking, "Well, how do you get help, groceries, things like that, interact with family?" I know there've been some wonderful people, younger people, often, who are getting groceries for older people and leaving it by the door, but the point is if someone has that relationship, they should take it rather than go out, right?

Dr. Efstathiou:
This is, depending on where you live, if you can, have somebody deliver it to your home. I know you have to get, if you're in a small apartment, you have to go out and about and take a walk, but be in a distance from everyone. Try to keep your spirits up. Don't always watch, all the time, the news. Get the information so that you know what we're up to. Don't spend hours and hours on the news. I mean, I'm a, let's say, younger female that don't hopefully have co-morbidities, and I'm a physician, and I watch the news all day, because I want to be updated, and it can get to you.
 
The most important thing is stay calm, stay positive, stay at home, and we'll get over this. Try to take advantage of the goodwill of so many people out there who want to help, and there's nothing wrong with it because older—I'll tell you something, Andrew, and it's not off-topic. One of the main reasons I actually picked prostate cancer as my passion is because I learn so much from my prostate cancer patients. There's so much human capital in people who are older, and we can't afford to lose that human capital. That is the most important part that I need older people to understand. That's why nobody is to be left behind, and we'll take care of everyone in the same way. This does not even cross our minds that there's any difference, because I know people think of that too.

Andrew Schorr:
Here's a question that came in from Rick, and he says, well, he finished radiation three years ago now, 2017, and his 
PSA went from 7.4 down to 1.8, but he still wonders should he worry?

Dr. Efstathiou:
Sure. We've taught our patients to look at PSA and be worried, but sometimes, it becomes the disease itself. The PSA becomes a disease itself that governs us. The main thing is to watch something and monitor it and see how quickly changes, how quickly goes up. If it doubles very rapidly, and one point then becomes, in a month, 3.6, then becomes 8, becomes 20, yes, some action needs to be taken, but you have all people sometimes might think we're exaggerating, because this can never be compared to a leukemia.
 
The PSA is just giving you a glimpse of a potential underlying growth. It's very rarely that this will be an immediate threat, and you have the luxury and the time to do something about it with your doctor in a more collected, disciplined manner rather than in a rush. That invariably will lead to errors and over-treatments that are harmful.

Andrew Schorr:
Okay. Let me ask—we didn't talk about scans. I want to talk about scans for a minute. My urologist wanted a check out what was going on with me. I had had an ultrasound of my prostate, and then later, for a certain reason, he wanted to do an MRI, which I had, which required going to the medical center, having that. Are those kind of things being deferred now or if you feel it's important, can I feel comfortable that the equipment, if you will, is sterile knowing about this virus on surfaces and stuff like that?

Dr. Efstathiou:
Excellent question. To the degree that I can defer an imaging modality, whether it's a CAT scan, an ultrasound, as you said, I do it to a degree. Let me say this would mean that 90 percent of my patients can wait for a month until we have a better understanding and control of this so that we can move on. But there are those men who will need it, and I prefer to actually take into consideration, speak to them, take into consideration whether they have access to a smaller facility that has more of a controlled environment rather than one of those big hospitals that would cater also to patients who come from the ER with such symptoms as you described.
 
That's what the discussion is. And each physician needs to calculate, again, the risk. Sometimes you have to do the imaging. I give orders to be done locally, and I give instructions. Small facility, make sure you ask that everything's sterilized. I know they're doing it, but for your own clarity and to feel more comfortable, ask them to potentially do it again. When you don't feel comfortable, ask them to do it in front of you. Maybe they will do it. I mean, anything can happen. It's very rare that I ask for things to happen right now, but yes, one out of 30 of my patients needs it right now, and it will happen.

Andrew Schorr:
Okay. Here's a question about masks. You talked about co-morbidities. In particular with an aging population, there are some people like me who do have this chronic lymphocytic leukemia.

Dr. Efstathiou:
Right.

Andrew Schorr:
Not common, but it is the most common adult leukemia, and it happens in older men in particular. We could be a double threat, if you will, prostate cancer and CLL. This gentleman, Norm, his doctor wants him to get a targeted therapy, rituximab (Rituxan), it's called. He comes in, an infusion, and he's wondering should he wear a mask, like if he had access to a N95 mask, should he wear that, so the whole idea of masks?

Dr. Efstathiou:
Okay, so this is a very important question. As of yesterday, MD Anderson did not require of us to wear masks, and every minute, everything changes. I can tell your—
the gentleman. What's your name? The name of the gentleman who's asking.

Andrew Schorr:
Norm.

Dr. Efstathiou:
Norm, I can tell you, even our physicians during a meeting yesterday, you could hear a hundred different views. People were saying that it has to be an N95, others saying, "Well, it can be a surgical mass." Others are saying, "If you're not being exposed to the droplets," which is the main reason, main way that this is actually transmitted, "then you're not in so much danger, if the patient is not symptomatic." Hundred different views.
 
We have to follow, in a way, in a very disciplined way, the guidelines. As of today, MD Anderson said both patients and staff, regardless of symptoms or no symptoms, are going to wear a mask. They're not going to have access to an N95, but they will have access to a surgical mask. Of course, N95 is a different level. It's probably better if you have access to it, but yes, as of today, our guideline is, yes, to do it.
 
We checked, and I spoke to a lot of colleagues from Hong Kong who have a more regimented discipline of doing their scientific investigation, and they said, "We don't have clear data that this virus is transmitted through the air unless you have a very high load of virus," and that is for patients who are in the ICU and are being intubated. As of today, we still believe that it is not transmitted through the air in a common area, but yes, the droplets are quite, quite obviously the way that it is transmitted, and wearing a mask will protect us to a degree.

Andrew Schorr:
Okay. Dr. E, can you give us just couple more minutes?

Dr. Efstathiou:
Absolutely. All the time you want.

Andrew Schorr:
Thank you. David asked a question, which we hear a lot about. We all want to know, besides the handwashing and staying at home and all those kinds of things we've talked about, related to diet, exercise and sleep, in other words, do you have any guidance about that? Also, if you go on the Internet, there's no shortage, certainly in prostate cancer, but "take this to boost your immunity and do this," and it's some herbal whatever. I want you to comment on that, but also the basics, what we should be doing so that we're as strong as we can be.

Dr. Efstathiou:
This is an excellent topic, and it takes so much more than two, three minutes to discuss. The bottom line is, and Dr. Fauci on TV keeps speaking about all these vitamins, is that we need to be careful, especially with patients with cancer when saying, "Oh, yeah, you can take vitamins." Any type of pill you take is a form of a medication. We know it well.
 
Just to debunk everything, some of the chemotherapies that we use for our prostate cancer patients originated from plants. It was a plant in the Amazon. A lot of patients don't understand that. There are a lot of toxins also when you ingest very strong, very high doses of these vitamins. What we know is, especially in prostate cancer and for good immune response, a good level of vitamin D is important. Most of the physicians check and give vitamin D, so your usual supplementation, which you did always for vitamin D, is fine.
 
Now, and actually this was discussed by Dr. Fauci as well, but when it comes, let's say, say to vitamin C, there were some old reports, all in New England Journal of Medicine, great journals, suggesting that if you ingest very high doses of vitamin C, which are two to three grams, it may help in some viral infection—may, may and also showing clearly that if you take these very high doses, you can have a lot of GI events such as diarrhea, diarrhea leading to electrolyte imbalance. And before you know it, you get dehydrated. You end up in a hospital if you're older. And it can lead to liver damage. All of the hormones that we give go through the liver. If your liver is damaged by overuse of, there goes everything, right? Back to being in an ER. So, don't take chances with this high dosing, follow the regimen that you always had. That's on the supplement end of things.
 
Diet. I mean this is how we spend our lives in the clinic, telling people to eat right, to exercise as much as possible given that you can't go out and do a lot of things with other people. Gyms are closed. But as much as you can do resistance exercise, a little bit of aerobic, sleep at least six to eight hours a day. This is the trifecta of immune response. And it's not patentable, but it is the reality. And try to keep calm. Don't watch those news before going to bed. Don't do it. Just don't do it. And don't look at it first thing in the morning.

Andrew Schorr:
Right, right. I'll make a couple comments on that. So we actually have a 22-year-old living at home, and he's gotten us watching, and guys, I don't know if you do this, but my wife and are doing, we've watched with him all the Harry Potter movies over the last few nights. But we've found escapist movies, not the news, not the serious stuff, but stuff that just takes us to another world. The other thing I would mention is also sleep. So now I have a question. I take a little melatonin to help me sleep. Any concern about that?

Dr. Efstathiou:
Not at all. Not at all. There's melatonin, there are other natural supplements, like even some of the teas like chamomile tea can help. These are absolutely fine. And when you're overstressed, we're all very concerned, but sometimes people use a little bit of an antihistamine when we say the PMs as we call them, that's okay too once in a while. Don't overdo it, like an acetominophen (Tylenol PM). Some people have symptoms with a little bit of pain, so just don't overdo it with these kind of supplements.

Andrew Schorr:
Dr. E, I'm just going to try to recap things for our audience as we wrap up. And you make sure, you're the professor, make sure I get it right.
 
So first of all, be in communication with your prostate cancer team who may be calling you, or even on video if you can do that, so that what do you do about your treatment plan or your concerns or any symptoms you have, and do that remotely. Stay home because you may well be older, and you may have co-morbidities, diabetes, heart issues, blood pressure issues, et cetera. Get people to help you like deliver groceries, things like that. Get sleep, have a healthy diet. Don't take a bunch of other pills that somebody's saying, "Oh, this is going to cure cancer or boost your immune system," and don't tell your doctor, right?

Dr. Efstathiou:
Right.

Andrew Schorr:
And as far as radiation, you spoke about that you didn't have a big concern, and that some things including clinical trial participation, some scans, maybe some blood tests. Your doctor, if you're at a big center like MD Anderson, might coordinate where it's done closer to home, right?

Dr. Efstathiou:
Absolutely.

Andrew Schorr:
Did I get it right?

Dr. Efstathiou:
You got everything right. Oh, we forgot to say, you'd better know that we're watching you eating these cookies. This is not the time to eat cookies and bad things. This is the time to learn to eat healthy, as you said, the right thing—not a lot of animal fat in there, not a lot of processed foods, not all these things in the wrappers. Please don't take this as an excuse.

Andrew Schorr:
Right. And one last thing, I'll tell you a gentleman, so I have a grandchild. Maybe you do. And so we, I'm getting great joy, she's only 18 months old. Yesterday on FaceTime on the iPhone, she called me what I want to be called, "Papa." And she said it clearly, and it melted my heart.
 
Would I have liked to have been there? Absolutely. But it made a difference. Oh, one last question that came in, Dr.  E., And then we're going to go, you know, some people have a drink or two or three. Any concern about alcohol and alcohol consumption?

Dr. Efstathiou:
Listen, this is a big discussion and we're pretty strict with some of the medication that our patients are on. I'm Greek, right? So we're all about having fun.

Andrew Schorr:
Ouzo!

Dr. Efstathiou:
I don't drink the Ouzo part, but you know, a nice glass of wine. So I do recommend to my patients just to keep it very social. So if you can do, a week I would go maximum, three to four glasses of wine over all, or something equivalent. Yes. There's a lot of stress. People want to, with your wife, sit down and have a nice dinner. I actually recommend to everyone to try to act normal, dress up a little bit at night, and have a nice dinner together. I know these are times to rediscover romance in a way. So I would say, yes you can, but don't go overboard. Just keep it very social. Even though we're in social distancing, right?

Andrew Schorr:
You've been great. I want to give you just one tip as I leave, you might suggest it to other patients. So we were supposed to go on a trip to Hawaii, and my doctor got ahold of me, this was like almost two weeks ago now and said, "You must not go." And I didn't go. But what did I start doing? I'm not doing it today is, I started wearing Hawaiian shirts around the house.

Dr. Efstathiou:
Perfect.

Andrew Schorr:
My wife through delivery, got some leis. I should've gotten her to get a bra with coconuts. But anyway, but the point is, shift your mind guys, 
shift your mind. And really I think it helps, it helps a lot. Walk the dog if you can, in an area that's not high density, get some fresh air in the backyard or wherever you can, and have a relationship with a wonderful doctor like Dr. E.

Thank you so much for being with us. You've been super. How do you say thank you in Greek?

Dr. Efstathiou:
We say, “efcharistó.” And Andrew, I want to say something to everyone who's watching. Another part that is very important that's coming out of this, the whole world, the entire world is fighting this, right? This social distancing is actually an opportunity for us to come closer together more than ever. There's not one doctor at the edge of this world who is not looking into it right now and trying to get over it. And all of us human beings are together against it. So just remember that, nobody's alone right now. We're all together.

Andrew Schorr:
Well, I've been saying this to our providers. I'll say it to you and your colleagues at MD Anderson around the world, you are our angels. So bravo. Thank you for all you do. We'll do our part in staying at home and in doing all the things that we can so that you can proceed, and if you can move your research forward and cure prostate cancer, amen! Okay, thank you so much for being with us today.

Dr. Efstathiou:
Thank you. Thank you all. Bye, have a wonderful week.

Andrew Schorr:
Bye-bye. Andrew Schorr here, just wishing you all the best guys. Continue to send in your questions to comments@patientpower.info. And for people you know, we'll get the replay of this program up on our coronavirus page on patientpower.info as quick as we can.
 
Wow, we learned so much and isn't she wonderful? I'm Andrew Schorr in Carlsbad, California near San Diego staying right here at home. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
 
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