ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore. I’m a photographer and editor here, and I’m also a long-time podcaster.

TODD ACKERMAN: I’m Todd Ackerman. I’m a former medical reporter and currently an editor at Houston Methodist. 

ZACH: And Todd, what do you know about prostate cancer?

TODD: I know some things. You know, as a medical reporter, cancer was a particular emphasis of mine, so I did a few stories on prostate cancer over the years. Here’s one piece of trivia I can tell you.

ZACH: Okay.

TODD: Do you know what the only other species that gets prostate cancer besides humans?

ZACH: I think I’ve heard this before, but I forgot. What is it?

TODD: It’s dogs.

ZACH: Ah.

TODD:  They think also that lions, but it’s not well studied for obvious reasons.

[Laughter]

ZACH: No, that’s a good bit of trivia. That’s interesting.

TODD: Yes, thank you.

ZACH: But like, so much with prostate cancer, there’s so much unknown. I have a family history with prostate cancer, unfortunately. So, this is a subject that’s really at the front of my mind a lot when it comes to health. And my father had it and his father had it as well. And unfortunately, my grandfather, he didn’t keep up with it. It was in remission, and they didn’t pay attention to it and then it came back, and by the time he got it checked again, it was too late, and it ended up being what he passed away from.

TODD: So, how old was he when he was first diagnosed and how old was he when he died?

ZACH: He was in his 60s and he died in his early 70s from it.

TODD: So, that’s not that slow moving for him.

ZACH: No, No. It’s just a matter of -- I mean, it’s a cautionary tale of, you know, getting your health checked, right? So, my dad was always on top of it, so that’s why he started getting checked at a younger age than normal…

TODD: Right.

ZACH: As they recommended when prostate cancer has been in your family. And he caught it right when we was around -- right around 50.

TODD: So, your grandfather did not have treatment, or he did have treatment --

ZACH: He did have treatment the first time but just didn’t -- didn’t follow up.

TODD: Yeah.

ZACH: It spread and that’s ultimately what he would pass away from. This was in the late 90s.

TODD: There was a lot of concern about the side effects of treatment back then I remember.

ZACH: But fortunately, my dad was on top of it, and he had treatment, like, immediately. As soon as it popped up, and he’s fine today.

TODD: I do not have it in my family history. I have BPH, an enlarged prostate, so that’s more of my concern.

ZACH: Mm-hmm.

TODD: But you know, they say prostate cancer is sort of a male concern as breast cancer is a female concern. I guess for you, that really hits home then.

ZACH: Yeah, absolutely. And we’re releasing this on prostate cancer awareness month so we just wanna shed some light on prostate cancer which, you know, I think is a cancer that people talk about it but still not as much as something like breast cancer for example.

TODD: It’s come a ways since what it -- there was a time when men just didn’t talk about it at all.

ZACH: Well, I mean that goes to a larger issue of just men, like, not -- not talking about health. Again, like my grandfather, he didn’t talk about his health, he didn’t check in on it, right? And then ultimately, like, that’s what led to him passing away from prostate cancer. So, you know, I feel like -- you know, I feel like we’re evolving as a society, we’re more comfortable talking about these sensitive health issues. If not with like, you know, everybody, at least with your close loved ones and your physicians.

TODD: And being aware and educated enough to know what the symptoms are -- when to talk to your doctor about it.

ZACH: Exactly. To that point, we talked to Doctor Michael Brooks. He’s a Surgical Oncologist who specializes in prostate cancer, and he gives us a real fly over of prostate cancer. The screenings, treatments, and probably most importantly, when you should start getting tested for it.

[Sound effect plays to signal beginning of interview]

All right, thanks so much for joining us today, Dr. Brooks.

DOCTOR MICHAEL BROOKS: Yes, my pleasure.

ZACH: Prostate cancer. It actually runs in my family. My father had it, my grandfather actually passed away from it, so it’s something that’s always at the front of my mind. But as a flyover here as we get started in our conversation, what causes prostate cancer and how common is it?

DR. BROOKS: Right, so I’ll start with that second part of the question first. So, prostate cancer, by far the most common solid organ malignancy, the most common cancer amongst U.S. men, okay? About one in eight men will be diagnosed with prostate cancer during their lifetime. Now, fortunately far fewer men die from prostate cancer than are diagnosed with it. That being said, it still remains the second leading cause of cancer death amongst U.S. men. It does tend to run in families. So, if you have a first degree relative like a father or a brother, you’re at substantially increased risk for being diagnosed with prostate cancer. However, the majority of men, since it is so common, do not have a family history of prostate cancer when they’re diagnosed.

ZACH: Hmm. Okay. So, how does it compare to other cancers?

DR. BROOKS: Like I said, amongst U.S. men, by far the most common, it is a very slow growing type of cancer, okay? The natural history of prostate cancer occurs over decades, meaning you could have prostate cancer, and ten, fifteen, twenty years later down the road be living with it still and not die from it, potentially undergo curative treatment during that window of opportunity.

ZACH: Okay.

DR. BROOKS: Which is something that is substantially different from other types of cancers. So, for example, you know, colon cancer, or even more aggressive cancers like pancreatic cancer. The window of opportunity for a therapeutic intervention is much shorter.

ZACH: So, you mentioned about one in eight men will get diagnosed with prostate cancer as a general figure, general number. But there’s not really a prostate cancer gene so to speak, like you said, it’s not necessarily -- It might run in families but there’s nothing really identifiable that you can trace, correct?

DR. BROOKS: Right. So, it’s a very complicated disease, alright? There are certainly genetic components to it, but there’s also environmental, potentially dietary factors, other factors that we still have not resolved yet, okay?

ZACH: Mm-hmm.

DR. BROOKS: Some men will have a very strong history of cancer in their family, and those men, rare genetic diseases that are heritable meaning they can be passed on from generation to generation, have been identified. For example, Lynch syndrome, or more commonly even than that, BRCA. The same genetic disorder that causes breast cancer in women has been identified as increasing the risk of high-risk prostate cancer in U.S. men.

ZACH: I think there’s a concern that the longer you live, the more likely you are to get prostate cancer, ‘cause a figure I found was that more than 75% of cases in men who are diagnosed with prostate cancer, they’re older than 65. Is it a correlation at all or is it just -- How does that shake out?

DR. BROOKS: Absolutely. The prevalence increases with age. But we know, since this is a disease that has a long natural history, the benefit of treatment in older men is lower than the benefit of treatment in younger men that are diagnosed earlier on in their lifespan. Meaning those older men are more likely to die of other causes. Heart disease more commonly, or other issues rather than the prostate cancer because the prostate cancer is very slow growing to begin with, in most men. Now, there are more aggressive forms of prostate cancer that are important to diagnose even in men as they get older. And the prevalence, unfortunately, for a high-risk prostate cancer also increases.

ZACH: So, does having benign prostatic hyperplasia, BPH, make someone more likely to get prostate cancer?

DR. BROOKS: Actually no. Two separate diseases.

ZACH: Okay.

DR. BROOKS: Yeah. Benign prostatic hyperplasia, very common, happens to all of us men as we get older.

ZACH: Okay.

DR. BROOKS: The prostate just grows with age. Just like your ear lobes. The prostate gets larger. Some men more than others, some men it causes symptoms, some men just live with it. Sometimes we need to initiate medications to help with those symptoms, sometimes we even consider surgical operations to help with more severe symptoms that are resistant to medications.

ZACH: Gotcha. So, that’s just more part of the aging process is what it sounds like.

DR. BROOKS: That’s part of the natural aging process that occurs in all of us and it affects us to variable degrees. So, some men will be affected earlier on in their lifetime. Those are men that often times do very well with surgical intervention, and that way we can get ‘em off of medications. Some men never have to worry about it during their lifetime, it’s just there.

ZACH: Gotcha. Now, when it comes to, you know, the symptoms of prostate cancer, like what are some of those symptoms? What are you gonna start to see that might give you the red flag of “Oh, I might have this.”

DR. BROOKS: That’s a very important question. So, the BPH and prostate cancer can cause similar types of symptoms, meaning lower urinary tract symptoms, going to the bathroom more frequently, more urgently, weak urinary stream, getting up lots at night. Those are common symptoms between the two. That being said, once you develop symptoms for prostate cancer, it’s usually incurable at that point.

ZACH: Hmm.

DR. BROOKS: Or at least the opportunity for treatment is better before you develop symptoms.

ZACH: Okay. So, to that point, when and how can prostate cancer be detected?

DR. BROOKS: So, that’s a really important question. That’s something that I’ve devoted a significant portion of my career to. It’s PSA screening, okay? So PSA, which stands for prostate specific antigen, is a simple blood test. The benefits of screening are increased as we touched on earlier, earlier on in life, and certainly before you develop any sorts of symptoms related to prostate cancer. So, these are in asymptomatic men between the ages of 50 to70 years of age, we wanna initiate screening, and that’s just a simple blood test. You can do it with your primary care physician. You can do it with a urologist. It only needs to be done once every one to two years in average risk men. Now, if you have a family history, then you wanna initiate that earlier. Forty-five years of age, potentially screening maybe a little bit more often, annually even if there is a significant increased risk for prostate cancer in your family. But that’s how we detect it before it’s symptomatic, and that’s when we have the best opportunity for treatment.

ZACH: I’m slowly closing in on 40 myself and having prostate cancer in my family, I know that well, sooner or later I’m gonna need to do that a little earlier than 50. ‘Cause 50 is when my father caught that he had it.

DR. BROOKS: Absolutely. So, you wanna do it five years in advance of your family member at least, that was diagnosed. So, typically if they were diagnosed early on in life, 45 is a good time to initiate a screening. That’s based on guidelines. But you could do it on your 40^th birthday, and that could have some benefit. Just to know what your baseline risk is.

ZACH: Gotcha. Now, you mentioned PSA scores. Can you talk a little bit about PSA and then Gleason as well.

DR. BROOKS: PSA, that’s again the blood test that we use for screening purposes, okay? Just a simple blood test. It gives us not only an idea of your immediate risk, but your long-term risk for prostate cancer. Also, if you’re diagnosed with prostate cancer, we use that as part of the risk stratification of your disease, okay? So, you get a PSA test, and then eventually, if you’re at risk for prostate cancer, we do additional testing with usually an MRI, okay? Which gives very detailed pictures of the prostate, allows us to understand if there’s any parts of the prostate, any areas in the prostate that are concerning for prostate cancer and can help guide a biopsy, okay? So, the biopsy, okay, is what determines whether or not you have cancer. Here at Methodist West, we do that with MRI fusion, we use state of the art technology to merge those MRI images together with a real time ultrasound to do a very precise biopsy. Okay. When we get the pathology result back, if it shows prostate cancer, okay, then that’s the Gleason score. Okay?

ZACH: Okay.

DR. BROOKS: Gleason score is a very complicated and confusing scoring system, alright? I like to tell my patients the reason it’s so complicated and confusing is ‘cause it was invented 50 years ago, it’s undergone a lot of changes over the last 50 years. We haven’t gotten rid of the scoring system because none of the current pathologists can agree who’s famous enough to have it named after them.

[Laughter]

ZACH: Okay.

DR. BROOKS: But we continue to use this. And even though it’s confusing even to medical professionals.

[Music to signal a brief interjection in the interview]

TODD: Dr. Brooks talked about PSA, or prostate specific antigen. PSA levels are measured in nanograms per milliliters. If your levels are considered too high, depends on a number of factors including your age, prostate size, and other symptoms. For men in their 40s and 50s, a PSA score over 2.5 is considered abnormal, while for men in their 60s, a score over 4.0 is abnormal. Four to ten means you’re at low risk, eleven to twenty means you have a moderate risk, and twenty one or higher means you’re at a high risk. The chance of having prostate cancer increases as PSA levels increase. A level under four means about a 15% chance of prostate cancer. A level over ten means more than a 50% chance of prostate cancer.

[Music]

ZACH: After the break, more about prostate cancer with Dr. Brooks.

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[Sound effect signals return to the interview]

ZACH: Can you talk a little bit about, and it might not be the most comfortable thing to comfortable thing to talk about, but a prostate exam. What can men expect when they come in?

DR. BROOKS: Right. Typically speaking, we don’t need to do a physical exam, what’s called a rectal exam, unless there is some increased risk for prostate cancer, and then it becomes beneficial, okay? And we know that based on your PSA testing. We do the PSA test, if there’s additional risk, we’ll examine the prostate, which means a physical exam in the office. Most guys tolerate it just fine.

ZACH: How treatable is prostate cancer? And what are some of the approaches to treating it? Like, obviously there’s surgery, there’s radiation. Can you speak on some of the pros and cons of either one? ‘Cause obviously you would recommend one or the other depending on certain circumstances, correct?

DR. BROOKS: Great question. I’m gonna back up just a little bit, just to say that the majority of cancers do not require treatment right away. Now, if you’re diagnosed with low risk or especially very low risk prostate cancer, then we do not need to initiate treatment. We can do something called active surveillance, meaning we can follow this cancer closely over time, surveying, doing intermittent PSA testing, potentially repeat MRI, a repeat biopsy to confirm the diagnosis. But we follow it closely, and we intervene if the risk changes, okay? Now if you have intermediate-risk or especially high-risk prostate cancer, those do require upfront treatment, okay? And what’s involved, the mainstay treatments: surgery, radiation, but we also offer ablative therapy with HIFU, high intensity focused ultrasound. We use state-of-the-art technology here, something called The Focal One HIFU machine. We can do treatment of just that spot of cancer or treatment of one side or the other of the prostate depending on where that cancer is. I’m a surgeon, and that’s what I do. I’m fellowship-trained to do state-of-the-art robotic surgery. We offer that here at Methodist West. Single-port robotic surgery, which is the most advanced form of this surgical procedure. Through a single, small, inch and a half incision, remove the entire prostate, remove the lymph nodes if necessary, and reconstruct the lower urinary tract alright? It takes about two hours. Patients are doing fantastic. Like I said, this is the most advanced form of the surgery. Some patients leave the hospital the same day as surgery because really the post operative pain, the recovery are very quick. And patients are doing very, very well. So, that is one option, okay? Is surgical treatment. Now, treatments for prostate cancer, they all have certain side effects, okay? That you have to be willing to accept. With surgical treatment, although patients recover their continence, their control of the urine very quickly after surgery, they can have a period of time where they have some leaking afterwards, okay? That is almost always temporary. The same thing is true with erectile dysfunction, okay?  So, patients can have some decrease in erectile function, but again, they recover over time, and we offer a full array of men’s health options to be able to help with that recovery.

ZACH: Okay.

DR. BROOKS: So, that’s surgery. And surgery also has certain advantages. One is that when you remove the entire prostate, you send it to the pathologist, you send the lymph nodes to the pathologist, we know your exact staging, your exact Gleason score and grading, and occasionally, there are changes between the pathology examined after surgery versus the biopsy specimen, your initial diagnosis, okay? So, we’re better able to prognosticate, understand what your long-term lifetime risk is from that moment going forward. The other advantage of surgery is that the only organ in the entire body that produces PSA, that screening test that we use, is the prostate. So, you remove the prostate, you remove all the prostate cancer cells, that PSA drops to undetectable. And so, you know very, very early on with a very precise biomarker whether or not all of the prostate cancer is gone. The third advantage of surgery is that if there’s any concern based upon the pathology specimen or based upon that PSA after surgery, you can do surgery and then radiation therapy to treat any residual cancer, but the reverse is a little bit more challenging, okay? The radiation therapy, the most common form is external beam radiation therapy. External beam radiation therapy. It’s photons. You can think of it like a flashlight focused on the prostate, but it’s invisible. You can’t see it. You come in for a course of 20-30 treatments over 4-6 weeks, and then you’re done, you know? The side effects initially with radiation therapy are very minimal for most patients. Patients, over time, can have some increasing lower urinary tract symptoms, they may have some erectile dysfunction similar to surgery, typically two or three years down the road after radiation therapy.  But the risk for leaking, urinary issues, that temporary problem after surgery is lower.

ZACH: Okay. So, I guess it’s a combination of the patient’s preference, and then if there’s any specific health reasons to do one or the other. Is there a specific health reason to, like, know you need to do surgery or know you need to get radiation?

DR. BROOKS: Absolutely. So, one of the things that we pride ourselves on here at Methodist and Methodist West is offering the full array of treatment options, and allowing the patient and the provider to make informed decisions, shared decision making regarding the treatment, okay? Because each individual is gonna be different. When it comes down to surgery, you know, if you’ve had, you know, a heart attack or a stroke or other major health issues in your past, you may want to avoid any of the risks of surgery, and just go with radiation therapy. Particularly if, you know, you’re a guy that’s getting older, 70s, 80s, 90s even. Although treatment at that age is a little bit less common, that is a good option because, again, there’s minimal side effects initially. Most patients do very, very well, and it avoids any of the risks of surgery. Now, if you’re a younger guy, you’re healthy, we know you’re gonna do great with surgery, then often times, that is a good option because again, we’re better able to prognosticate, understand what your lifetime risk is after the procedure, and guys are just doing fantastic. Now, the third option, which we haven’t discussed as much, again, is something called HIFU, high intensity focused ultrasound. This is a third option. We typically reserve it for men in the intermediate risk of prostate cancer. Not the most aggressive, but also not the least aggressive that we can just follow safely. Somewhere right in the middle. Those patients can also do very, very well with just ablation, alright? HIFU is a single day procedure. You come in, you get it done under anesthesia, you go home the same day. Minimal side effects associated with it in the short term. And most patients that receive it, that’s all they need. They’re done.

ZACH: That was exciting. And how new is that technology?

DR. BROOKS: It’s been approved in Europe and other countries for a decade or two. It’s most recently approved here in the United States in the last few years.

ZACH: Okay.

DR. BROOKS: One of my partners, David Mobley, has led the charge here at Methodist and Methodist West in terms of HIFU treatment. I’ve also offered that procedure. We have state-of-the-art equipment to be able to deliver that safely and effectively for patients that are good candidates.

ZACH: It’s great to see how the technology has evolved because even, you know, 30, 40 years ago, it was basically just surgery maybe, and then radiation as well. But now there’s ultrasound technology. So, as we continue to find new ways to treat this cancer, it’s exciting stuff.

DR. BROOKS: Yeah. And ultimately the goal being to offer effective treatment with lower side effects, quicker recovery, men getting back to their quality of life.

ZACH: Absolutely. So, talk about the process of after you have prostate cancer, but take it a step back to, you know, if it does run in your family, like me for example, what can you do and is there anything you can do, really, to help prevent prostate cancer from developing, or even slowing down its development?

DR. BROOKS: That’s a really good question. That’s a fantastic question. Unfortunately, I don’t have a great answer for you. This is something that’s been studied in large, national, clinical trials and international clinical trials looking at medications, looking at antioxidants, selenium, vitamin E, other things. Unfortunately, nothing so far shows a high level of evidence in terms of preventing prostate cancer. Again, it’s a complicated disease. That being said, I think certainly, you know, eating a well-rounded diet, getting plenty of exercise, you know taking care of your general health is always important…

ZACH: Yeah.

DR. BROOKS: For your recovery after surgery if that’s something that you ultimately end up needing, and just for your long-term quality of life.

ZACH: Yeah. And obviously it’s not gonna hurt you if you’re eating healthy and exercising, taking care of your health in general.

DR. BROOKS: Absolutely. It may not prevent prostate cancer unfortunately, but if you’re unfortunate and you are diagnosed with prostate cancer, it will benefit your recovery, benefit your long term quality of health, benefit you in terms of your men’s health, erectile function and other important things that go into just living a quality, you know, meaningful life.

ZACH: Yeah, excellent. I have seen, you know, people doing, like, carrot smoothies and tomatoes and all sorts of things, and yeah, those are healthy, that’s gonna help you but it’s not necessarily gonna be an A to B correlation of, “Oh, if I drink my tomato drink every day, it’s not gonna keep me from getting prostate cancer.”

DR. BROOKS: Absolutely. And unfortunately, that’s the case. But again, doing those things, making sure you get plenty of micronutrients like lycopene, which is found in tomatoes, and has been suggested as a potential preventative measure for prostate cancer. Those are important things to do, as are just taking care of your general quality of life, making sure that you maintain a good, healthy body weight, you’re getting plenty of exercise, well rounded diet, and plenty of sleep too.

ZACH: Oh yeah, sleep. Always important. It’s funny, the more podcasts we do and the more topics we cover, it’s always the same advice, right? Just take care of yourself, right?

DR. BROOKS: It’s the hardest advice to follow. It’s hard for even us doctors too, to do that. But it is important. And the work and the effort you put in today is not only gonna benefit you next week or next year, but ten, twenty, thirty years down the road.

ZACH: Alright, so wrapping up Dr. Brooks, what message do you wanna leave our listeners with about how they should approach prostate cancer if they have it themselves, if they have a loved one who has it. What would you like to say to wrap us up today?

DR. BROOKS: Absolutely. So, one thing that is really important is to understand that each patient diagnosed with prostate cancer, their journey is gonna be different, okay? Your journey, your experience is gonna be different from your neighbor’s, it’s gonna be different, potentially from your own family member’s, your brother, your father. You need to seek out expert advice, link up with a provider that you trust, okay? That you are able to develop a relationship with so that they can understand what’s important to you and your quality of life, and understand your prostate cancer risk, and then help guide you through the whole journey, before, during, and after treatment.

ZACH: Excellent. Well, thank you so much for your time today, Dr. Brooks.

DR. BROOKS: Yeah, my pleasure.

[Sound effect signaling end of interview]

ZACH: So, Todd, I actually haven’t had a PSA test yet. I know it’s coming up for me ‘cause I’m closing in on 40 which is that target range for getting tested for prostate cancer, especially if it runs in your family. But what’s been your experience with PSA testing?

TODD: Well, I started getting them when I was your age, or even a little younger.

ZACH: Really?

TODD: Just ‘cause we have a wellness program at my former job, newspaper job, in which you would get your cholesterol, your lipids tested, but there would also be a PSA test in it. So, I would get those every four years or so for a while until they finally ended the program ‘cause of cutbacks in the industry. But my PSA level was always great. It was 0.4.

ZACH: Okay. That’s a really good score.

TODD: Yes. Anything under one is really good, so. And it didn’t change over the years we did it. I haven’t had one in a while.

ZACH: Mm-hmm.

TODD: I probably should go in and have one although I’m getting close to the age where it’s not even -- they say it’s not any great use to do ‘em. I think he mentioned 50-70.

ZACH: Right. It’s ‘cause at some point it’s like well, you can have an enlarged prostate or --

TODD: It’s so slow moving that they’re not gonna treat it anyway.

ZACH: Exactly, exactly. I was surprised to hear though, ‘cause I’ve always thought like, you know, tomatoes, carrots. Like, I’ve seen people do this, right? Like, “Oh, I’m gonna just stock up on these foods.” And then the properties that they have, like, that’re not gonna hurt you, they’re healthy. And it’s good to consume a lot of those, but it’s not necessarily a preventive activity. Like, if you just drink a lot of carrot shakes, it’s not gonna keep you from getting prostate cancer, you know?

TODD: No.

[Laughing]

I would not think that would do it. You know, at one point, there was a lot of excitement about like saw palmetto…

ZACH: Mm-hmm.

TODD: As a supplement. And that’s one they actually have done a lot of testing with, and it just did not show any promise at all for preventing prostate cancer.

ZACH: Yeah, I mean, it just seems to be one of those diseases that there’s a lot they just can’t nail down, right? Like we talked about, there’s no prostate cancer gene, right? They don’t understand why certain people might have it and others don’t. That sort of thing. There’s a lot of speculation but no hard facts. As far as we’ve gone, in our medical advancements, we still can’t, like, print it all out in black and white, right?

TODD: Yes. It’s interesting that so much of the time, it’s not a killer.

ZACH: Mm-hmm.

TODD: I can remember this from an interview I did back in my medical reporting days, talking with a prostate cancer doctor. They did autopsies on men who died of other diseases, and 50% of them had prostate cancer.

ZACH: Hmm.

TODD: So, that’s where the phrase comes from “Most men die with prostate cancer, not of it.”

ZACH: Mm. Yeah. I mean, that’s true. And also, it’s a silver lining to all this is it’s a very treatable cancer, right? If you catch it early…

TODD: Yes.

ZACH: And you go through the proper steps, there’s a really good success rate of surviving it.

TODD: Right. At the same time, the five-year survival rate for prostate cancer in your 50s through your 70s is like 99.5%.

ZACH: Mm.

TODD: There’s like no other cancer -- maybe testicular cancer is very well cured too. But it’s a lot better than if you have breast cancer. Something like 235,000 men are diagnosed with prostate cancer every year, which is still a fraction of how many have it.

ZACH: Mm-hmm.

TODD: But 33,000 die. So, I mean, that’s the second highest.

ZACH: Right.

TODD: That’s still not a terrible number, I don’t think. And when are you gonna get that PSA  test -- you know, we talked about you getting the cholesterol tests, and I’m betting you haven’t done that yet.

[Laughter]

ZACH: You know, Todd, I appreciate you calling me out for my lack of follow through. So, I’m definitely gonna do the PSA test, but I’ll get back to you on that cholesterol test.

TODD: Alright.

ZACH: Alright. Fair enough.

TODD: We’re keeping eyes on you.

ZACH: I appreciate that, and I know it’s because you care.

TODD: Yes, absolutely.

ZACH: Well, that’s gonna do it for this episode of On Health with Houston Methodist. We drop episodes Tuesday mornings so be sure to share, like, and subscribe wherever you get your podcasts. And until next time, stay tuned and stay healthy.

[Music ends signaling end of episode]