Category Archives: Cycling

July 2017 blood test

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I had a blood test just before going away for 2 weeks to France so didn’t get the result until I phoned yesterday. The PSA level is still 0.01 so good news. This is the 4th blood test since my radical prostatectomy, 0.02, 0.04, 0.01 and 0.01, so things are as good as they can be at the moment.

I spoke to the specialist nurse today to find out what my Gleason score was after the pathology tests on the removed prostate and surrounding tissue. It was 3+4 so a total of 7. He said only 50% in my condition would get a recurrence and only 50% of them would go on to further treatment. An article I referred to in an earlier post gives this table:

WHAT THE NUMBERS MEAN
If you have a Gleason score of 5-7
Your PSA increased more than two years after surgery

AND your PSA doubling time was greater than 10 months:
Your chance of not developing metastasis(having a bone positive scan) in:

      • Three years:  95 percent
      • Five years:     86 percent
    • Seven years:  82 percent
OR your PSA doubling time was less than 10 months:
Your chance of not developing metastasis in:

      • Three years:  82 percent
      • Five years:     69 percent
    • Seven years:  60 percent
OR your time to first PSA recurrence was less than two years:

AND your PSA doubling time was greater than 10 months:
Your chance of not developing metastasis in:

      • Three years:  79 percent
      • Five years:     76 percent
    • Seven years:  59 percent
OR your PSA doubling time was less than 10 months:
Your chance of not developing metastasis in:

      • Three years:  81 percent
      • Five years:     35 percent
    • Seven years:  15 percent

I was also told that the post operation pathology on the tumours were graded at T3a. This implies a locally advanced cancer, i.e it has spread beyond the prostate capsule, but it has not spread to other organs. My seminal vesicles and a surrounding margin was removed to be on the safe side. Another paper concluded:

Survival was significantly different when comparing pT3a to pT3b groups. The 5-year overall survival (OS), cancer-specific survival (CSS), disease-progression-free survival (DPFS), and biochemical-progression-free survival (BPFS) were 96% versus 72%, 98% versus 77%, 97.3% versus 79.3%, and 60% versus 24.2%, respectively. Specimen Gleason score was the most significant predictor of OS, CSS, DPFS, and BPFS. The risk of death increased up to 3-fold when a Gleason score 8–10 was present at the final pathology. Conclusions. Radical prostatectomy may offer very good CSS, OS, DPFS, and BPFS rates in pT3a PCa. However, outcomes in patients with pT3b or specimen Gleason ≥8 were significantly worse, suggesting the need for multimodality treatment in those cases.
https://www.hindawi.com/journals/au/2012/164263/

This is also promising for me.

Exercise, not being over weight and maintaining a high level of general fitness and health, although there are no guarantees, are highly correlated with remission and higher survival rates. At the moment I am 13 stone 12 lbs, about a 10 lb heavier than when I had the operation last August. The plan now is to get back to 13 stone over the rest of this year. To this end I will be buying a smart trainer for my bike and start training and get involved in on-line racing using Zwift and a Facebook group called The Big Ring. This will involve a significant investment but but it is literally for life.

Today’s post prostatectomy consultation

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I made some notes on questions to ask Mr Sing in a recent post Decisions. He was able today to give me a little more detail.

The apex of the prostate where my tumour was pressing on the surface in fact has no capsule so dissecting this area is not so clear cut as the prostate goes right up to the pelvic floor muscle and it is not possible to take as wide a margin for testing as it is elsewhere. Dmaging the floor muscle could lead to permanent incontinence. The sample tissue sent off for testing showed some small areas of limited and focused cancer cells but there is no way of telling if these had gone any further into the surrounding tissue. The dissection is done with an electrical current and it is possible that any cancer cells outside of the incised margin may have been killed off anyway.

I was shown pictures of my prostate and there was an awful lot of cancer marked in red! I forgot to ask if it was confirmed as stage T3a but can ask on the phone which I will tomorrow.

My PSA was confirmed as 0.02, described as very encouraging, especially due to the small and focused positive samples. Although PSA is not a reliable indicator or prostate cancer while you still have one, once removed it is very reliable. It’s early days but there is a good chance it will go down to zero over a little more time and they will check again and arrange another meeting in 6 weeks time. If it rises, especially to over 0.2, then radiotherapy will be recommended. Even then, if left alone, it could be many years before it developed into a recurrence of a discernible cancer tumour.

The standard procedure from here on would be to simply monitor my PSA level and only offer further treatment if it reaches the 0.2 threshold. 50% of men in my condition will not need this. Of the remaining 50% a large proportion will still be cured and the rest most would be able to keep it under control fr many years before palliative care became the last option. This seems to warrant quiet confidence.

I still have to make a decision about whether to go into the trial in which I may be assigned to the group that has radiotherapy more-or-less immediately. At the moment my feeling is that I am likely to be in the 50% who won’t need it based upon my own strategy of nutrition and exercise to stop the cancer developing. I’ll need more information from Dr Owen next week.

Mr SIngh seemed mildly surprised that I have had no problems whatever with incontinence and that I played in my first racketball tournament last week, 9 weeks after my operation. I also mentioned I had just got back on my bike this weekend for very short distances. He didn’t say anything to dissuade me other than to remind me I had had major pelvic surgery. I’ll check this again by phone tomorrow. Also I need t check if it is advisable to not ride for a few days before PSA tests as was the case when I still had a prostate. Could it irritate the residual cancer in anyway and produce a higher reading?

On my bike

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1964 Portsmouth Road SCCU 25 mile time trial championship. Finished 6th aged 18

The first thing I turned to when I decided to get fit again and lose weight was cycling. As I said in the introduction to my cycling blog, Bicycle Diaries,  cycling had been my main sport from 1962 at the age of 16 to my late 30s when I finally gave up racing. Since then, through the 1980s and 90s, I continued to cycle occasionally for pleasure. This has included touring in France on solos and on a tandem, particularly in the 1980s, the Sea to Sea and other Sustran’s routes. However, I have rarely used my bike over the last 15 years or so. The details of how I got back into cycling for fitness in July 2012 can be found in the initial blog post Starting Again so I won’t repeat that all here.

Social ride to Beninborough Hall August 2013

As a way of getting fitter cycling has been ideal and certainly worked for me. I enjoy the social rides I go on from time to time with the Leeds Cycling Campaign social group on Saturday mornings and still hope to go more regularly on the Sunday morning intermediate and, in due course, longer rides. Last year I started to organise informal social rides with members of the Bradford U3A racketball group (the subject of a future post). I had hoped to develop these rides this year but after my mountain bike crash in April in which I ruptured a kidney the summer was pretty well lost as far as cycling was concerned and it never happened. I still intend to do this next year. By now I was hoping to be riding sportives and audaxes and entered one. the Lincoln Arrow, earlier in the year. This also fell victim to the crash. However, I returned to Bergerac in France early July and rode the circuit there that had got me going again 3 years earlier and am well on the way to recovery now, ignoring for the moment that as a result of my stay in hospital I have since been diagnosed with prostate cancer. To cut a long story short, it is a low grade, low risk slow growing variety (as best they can tell so far) so I am on the ‘active surveillance’ programme where they keep an eye on it and are prepared to act swiftly if things change for the worse. I’ve reproduced both these posts here and they follow this one.

Cycling will continue to be a central part of my fitness regime for a number of reasons. I still very much enjoy it, the sense of simplicity and freedom, the experience of connection with my surroundings and movement on a human scale. I read somewhere and I hope to find it again somehow, that the ideal scale for life in the future will be that which can be encompassed in a days cycle ride. In Copenhagen about 45% of journeys each day are by bicycle. In Leeds and Bradford it is about 1% I believe. In common with many other cities now, Leeds and Bradford are making serious efforts to improve cycling infrastructure and encourage people to cycle for short journeys and commutes. So many different agendas are addressed by this – health, morbidity and obesity, environmental pollution, stress and mental health, generally well being. Hopefully cycling will become a safe and routine way of getting about in our area.

Health and fitness – summary

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Health and fitness is one topic I will be posting about here but by no means the only things. However, since my retirement in July 2013 at the

age of 67 and a doctor’s earlier warning that at nearly 18 stone with high cholesterol and blood pressure I had an excellent chance of not making it much beyond 70, I decided that whatever other plans I may have for retirement they would all depend crucially on staying alive and this should be my initial priority. In fact I had made a start on this in July 2012 when I was inspired to start cycling again by Bradley Wiggin’s Tour De France victory. I say ‘again’ as cycle racing, along with squash, had been my main sports between my teens and when I gave both of them up at 40. I had never quite given up cycling altogether and had,

August 2003 in France

for the previous 20 years or so, undertaken one or two purely social rides on flat, short mainly off road routes with friends. I still had a couple of bikes in the garage and a now 30 year old turbo trainer so I started doing 5 minutes on the trainer most days and eventually short rides of 5 miles or so round the local roads.

Around August 2013, a year later, I started playing racketball, a variant of squash, with a view to getting back into squash too. Racketball is less technically challenging but just as physically demanding in terms of endurance if not speed and flexibility.

Me and Laura Massaro May 2014 National Squash Championships, Hull

Some call it old man’s squash! I enjoyed it so much and, once I recognised I would never get the speed and flexibility at 67 that i had in my 20s, I decided to stick with racketball. For what I wanted, a good workout, sociability and competition, it ticked all the boxes. The full story of all this is recorded on another blog I started in October 2012 called Bicycle Diaries. Recently the posts have been about a mountain bike accident and my diagnosis of prostate cancer but most of what preceded these are mainly on cycling and fitness. In addition I started walking a few days a week; anything between 30 minutes and 2 hours. I tried to work this into my everyday activity as a mode of transport on the days I didn’t play racketball or go out on my bike. The idea was to have at least 40 minutes activity everyday or at least most days when this wasn’t possible for some reason or another.

I soon learnt that as far as weight loss is concerned exercise would not be enough so I started modifying my diet. I signed up to MyFitnessPal to record my food and calorie intake and, with the help of a Garmin Vivoifit, calculated and recorded my exercise calorie burn. This wouldn’t work for everyone and can get a bit tedious but for me it works and over the 3 years I’ve been taking this seriously I have got down from 17 stone 12 lbs to 12 stone 10 lbs. This has been slow and steady and by making fairly small incremental changes to my nutrition and life style. I’m now fairly confident that I can maintain this without too much effort. I still enjoy the occasional over large meal and fairly heavy drinking at family celebrations and other similar events but these are always now fairly isolated one-offs and I easily drop back into my normal routine. In fact even my over eating and drinking is quite a bit less in volume than it used to be.

That’s the summary. I will post here with a bit more detail on individual aspects of this – cycling, walking, racketball, nutrition – in due course, partly for my own record of ideas and information and perhaps if I get any, answers to questions.