DR SHIMM: After my dad’s prostatectomy, he had positive margins and his PSA never went down. He was on Lupron until he started chemo.

Although he has bone mets, he has been asymptomatic from them. The toxicity he has experienced — lassitude and intellectual dullness — is not from the disease, but from the treatment.

He’s a retired law professor and just can’t quite get things straight anymore. His weight is about the same, but his waist is about four inches bigger, so he’s gaining fat and losing lean body mass. The hot flashes are also an issue, although these have stopped now that he’s off Lupron. A lot of patients complain about the hot flashes.

I assume we have the bone density loss pretty much under control, at least theoretically, with the bisphosphonates — provided patients receive them. I’m more concerned about how to deal with the day-in and day-out grinding-down effect of some of these drugs on a patient’s quality of life.

DR LOVE: How old is your dad? How long has he been on therapy, and how has his lifestyle changed while he’s been on therapy?

DR SHIMM: He’s 78 now, but he was a healthy 72-year-old when he had his prostatectomy. He had recently retired and was very active, running daily and traveling a lot to visit my wife and me and the grandkids.

At this point I wouldn’t call him housebound because he goes out and still drives, but a long trip is out of the question for him. He takes a lot of naps and has certainly given up all kinds of exercise.

DR LOVE: And how was the metastatic disease picked up? Symptomatically or just in scans?

DR SHIMM: Just by scans.

DR LOVE: So, he has asymptomatic metastatic disease?

DR SHIMM: That’s right.

DR LOVE: And his life is not very pleasant right now because of the treatment?

DR SHIMM: Exactly. The impairment of his life is solely because of the treatment, which is not to say the treatment hasn’t done him some good, but he’s experienced a fair bit of toxicity.

DR DEETHS: My personal experience was that I went through a period of depression, and you wonder whether men with metastatic disease might have an element of depression that is really not recognized, and whether that can be part of the disease process and the treatment process that we, as physicians, overlook.

DR LOVE: Can you talk a little bit more about what was going through your mind in that regard?

DR DEETHS: My initial feeling was that I was going to die from cancer, which is a typical reaction. As I mentioned, for six months I wouldn’t buy any new clothes or shoes or socks or anything, because I felt that I had enough in my wardrobe and I was not going to outlive anything that I bought. I realized that I was depressed and I talked to my personal physician, but I didn’t believe I needed any medication.

Even now, seven years later, I go through periods during which I feel sort of down. I know it probably stems from my diagnosis more than anything, and every day I’m reminded of it — either by a little bit of incontinence or an urge or the stress of incontinence, or when you go to have sex and have to use some pill or device. I realize other men do that but it causes stress. I use CarboJet™.

DR LOVE: Another thing that becomes an issue for a lot of people is the marital relationship.

DR DEETHS: My wife tends to not be very introspective about things — about her own health and so on, and she did not give me a lot of support initially. I was getting more support from my office personnel.

As far as intimacy, our personal relationship actually improved after about six or eight months. You realize that you’re not going to die right away, but you also realize that life does end and you never know how much time is left.

The hugging and the kissing and the touching became very important and that part of our relationship really improved. I think we both feel that way.