Tuesday, September 27, 2011
Many options for treatment of prostate cancer
Dr. Michael Camardi
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About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to email@example.com with “Age Matters” in the subject line.
Dear Dr. Camardi:
When I heard that you were undergoing surgery for prostate cancer and what you did for my family just two months before you went under the knife in our battle with this same disease is simply amazing.
You were as cool as a cucumber and so calmly had the patience with us, carrying on the way we did, and took the time to deal with my husband, his father and my brother, let alone me with the state I was in, when we were trying to figure out what to do. That you had the same thing and never let on leaves me speechless.
That my brother was not even your patient and you still reached out to him when I asked you to and settled us all down when it was just crazy for all of us and explained all these scary and confusing medical things and choices is something we all will never forget.
I hope you are well and was told by the office that you are back now and we will be seeing you in a few weeks.
Well, Dad is finally going to get the radiation from the outside like you said because at 83 with his breathing and his heart and all, that's about all he can stand. My husband is going to have surgery like you did next month. And my brother, with all of this going on right now, will be doing "watchful waiting" and get another biopsy in six months.
I hope that's the right thing for him but that's all he can put up with right now until he sees how Daddy does. It has been a time for all of us all right. God bless.
Yes I would say that it has been challenging for all of us!
Allow me to say that I am fine and back doing what I like best. Thanks for your kind note, but please do not take my not relating my condition to your families in the wrong way.
Early on in one's medical education you are taught to be objective in analyzing a patient's case and needs so that I do not cloud your judgment through my situation.
While the disease may be the same, each person has different emotional and medical needs.
Your note illustrates this principle quite clearly in that there are many choices in prostate care. What Dad chose was different from what your husband will do and distinct from the road your brother will travel. The range of treatment options range from radical surgery to wait-and-see.
Let me take this opportunity to remind you to make sure your two sons are evaluated by their doctor for prostate cancer due to the genetic risk as we discussed.
In all diseases, but prostate cancer especially, vigilance is so important but it has a certain viciousness, if you will, about it. By this I mean that complaints one might ascribe to other chronic or mundane aches and pains could be explained away as "old age" when in fact they are the first signs of a potentially life-changing event.
For example, recall why you first brought Dad to see me: It was for his back pain.
It was only as I examined and studied him that we came to find out that the prostate was to blame for his pain in his back. I can still see the shock on your face when I told you, but Dad just listened and said, "well what do I do now?" - which is so typical for geriatric patients: Their age has given them a developed mental toughness that is a joy to work with and an inspiration to see.
Now think of your husband: He came in for a routine physical without a complaint in the world and the prostate blood test I ran for him came back with a result that called for a biopsy. The result showed he had early prostate cancer. He had no physical signs nor symptoms and a perfectly normal exam and yet as he said, "you're trying to tell me I'm walking around with cancer inside me?"
The picture presented by your brother was one where he was getting up more frequently at night to urinate but he knew from previous exams that his prostate was enlarged and was taking medication to control it. He thought he would get an adjustment in his prostate medication and be fine. When he went to his doctor the exam had not changed but the blood test did, which once again took him to a biopsy and the cancer was found. From my telephone conversation with him, he seems to be in denial, which also is so very common, and his position on all of this was, "I really don't have any time for this."
And that is such a human dimension to our busy modern lives yet this disease is a game-changer in many ways and it forces us to look at our mortality sooner than we would like.
The real good news in his case is that he seems to have a good and caring physician who is working with his frustration and anger, and working with him toward a solution once he comes to accept his diagnosis.
Now the other good news: I can say that in my 33 years of following the prostate patient, the choices and the state-of-the-art have never been better. The progress our urological colleges have made in the management of all stages of this disease has been impressive.
Make no mistake, it still is not a walk in the park and can be a draining experience but far, far better than that which patients went through in the past.
So here is how I look at all of this: It is naive in the extreme to think that disease will not strike at us sometime in this life. So keep an open mind and watchful eye for something to happen, especially as we age.
And if you find that "something," approach it aggressively and treat it wisely â€ as if your life depended on it!
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging and an assistant professor of medicine of the Virginia Tech Carilion School of Medicine. His column runs monthly in Extra.