Today’s post prostatectomy consultation

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?

Protein – good or bad

The answer is, potentially both depending on other factors.

Will a high-protein diet harm your health? The real story on the risks (and rewards) of eating more protein. Article from Precision Nutrition web site. The evidence suggests that some of the harmful effects correlated with high protein diets are just that, correlations based on unreliable observational studies, and in any case are reversed with individuals over 65.

Prostate cancer and nutrition

I intend to ask at my next appointment with the consultant if there is any nutritional advice available for helping control the development of prostate cancer. I will keep any information I get in this blog. At the moment I am investigating soy products like soy milk and tofu and also flax seed (otherwise known as linseed). I’m alos looking at a range of herbs and spices.Evidence for and against will be linked to.

For starters, here is an article Flaxseed and Prostate Cancer risk  from the Oncology Nutrition website. From the same websiteProstate Cancer and Diet

Does turmeric really help protect us from cancer? from the Trust Me I’m a Doctor BBC series.

On the dairy milk controversy: Is Milk Your Friend or Foe? Looks like yogurt and cheese are still beneficial and modest amounts of milk, i.e. in tea, are OK too.


After a couple of postponements I will now be seeing Mr Singh on Wednesday 26th of this month, October, at 11.30 and Dr Owen, the radiotherapist who is conducting the trial I’ve been invited to join, at 4.00 pm on the 3rd November. (The Radiotherapy and Androgen Deprivation in Combination After Local Surgery trial, conducted by the Medical Research Council, and the Radiotherapy—Adjuvant Versus Early Salvage (RAVES) trial)?

Questions for Mr Singh:

What was the result of the tissue tests on the prostate and surrounding margin where the tumour was poking through the capsule? I have been told the stage was confirmed as T3a.

In that area the prostate was stuck to the surrounding tissue. Was this because of the tumour or because of damage done by the targeted biopsies in that area?

The tissue margin tested positive so there are cancer cells present. These are presumably still prostate tissue and cause or contribute to the residual PSA level I have of 0.02. Is that correct? What does a positive margin mean? How deep a margin was taken? Cancer to edge or not quite so far? Artefact of surgery (iatrogenic intraprostatic incision) or already there before the operation? Was the positive margin adjacent to the prostate apex?

Could these cells produce tumours and if so how long might that take? I was told that it could take years for tumours to be detectable by scans or not happen at all. Can any of these cells move into the blood stream or lead to tumours in other organs or bones?

General prognosis I was offered is that 50% on PSA monitoring would not develop further cancer. Of the other 50% half would respond successfully to further treatment, radiotherapy e.g. and half would not. I didn’t make a note of these figures so I may have mis-remembered. Are these figures correct?

What do the statistics show in terms of the likely time period before radiotherapy is recommended? Are the majority 1 or 2 years or is 3 to 5 more typical? The issue here is that the older a patient gets the more likely the recovery will be affected and suffering from side effects.

If I stay on observation and PSA monitoring how often would this happen and what would trigger concern and a recommendation of further treatment? What would the monitoring be looking for in order to trigger radiotherapy and how quickly would this be commenced.

Is there any expert nutritional advice available for my condition?

Questions for Dr Owen:

What of the new more accurate and targeted therapies? I’ll get a name for these.

Do they take a scan to identify where in the pocket where the prostate used to be (the bed?) to identify sites that need targeting? I understand that once the prostate is removed and the radiotherapy is targeted at the prostate bed it is difficult to measure up and reliably direct radiation and that there is a danger of over dosing the bladder and bowel. Is this correct?

I’ve more time to think about this but would be mostly concerned with the actual procedure and possible side effects, what they could be and how probable. The main ones seem to be incontinence, erectile dysfunction and damage to the bowel. I would need to know how long these tend to last or if they can lead to permanent conditions.

Look at

Positive surgical margins following radical prostatectomy


Trust me, I’m a doctor

A few notes on the first in the new BBC series, broadcast tonight. It was of particular interest to me as it dealt with the effectiveness of whey protein as a muscle builder, how to slow down or even reverse muscle loss as you get older and what are the best times to exercise for weight loss with respect to eating. It also looked at the claims of taking fruit smoothies as a source of antioxidants. To summarise the findings:

Protein powders do not increase muscle growth providing you are getting sufficient protein in your diet. Any surplus is burnt as energy, is stored as fat, or is peed out of you system. The role of protein powder as part of a weight loss strategy was not considered in the programme. However, tests showed that protein supplements pass into your muscles in about 3 hours and the uptake is more in muscles that have been exercised.

Muscle loss starts in the over 40s at a rate of about 1% per year and after 50 at about 5% per decade. This is inevitable and is part of the normal ageing process – sarcopenia. This leads to loss of strength and power output as well as part of the reason balance deteriorates with age. The programme demonstrated how a few simple exercises done in the home without special equipment and generally without raising a sweat (so presumably not a cardiovascular workout) enabled a group of late middle aged and older subjects, over a 4 week period, have a 3% increase in muscle volume, a increase in strength of 12% and a power output increase of 13%. No special diet conditions were set.

The effects of exercise for fat burning were measured comparing subjects that exercised before eating in the morning and those who exercised after. Apparently the fat burning effect takes place in the hours after exercise and not so much during. This was not explained but it may be because the fat is used to replace carbohydrate energy stores in the blood. The effect was about 3% to 8% additional fat burn for men who exercised before eating and the same for women who exercised after eating. This is a new finding and may be explained by men having more muscle than women and the way the different sexes utilise energy.

Antioxidant drinks have no effect. If anything they produce an antioxidant spike that the body responds to by decreasing the amount of internally produced antioxidants so that the normal level is reduced and does not recover for 24 hours. So the supplements are counter productive. In any case, free radicals are necessary as they signal muscle damage has been done and repair mechanisms kick in. The balance between antioxidants and free radicals is managed by your body automatically.

The final snippet of information concerned looking at if being overweight was necessary a bad thing and whether fat loss was always something beneficial to strive for.  Fat round the bum and legs, hips generally, was not seen as particularly dangerous but round the stomach and abdomen definitely bad. BMI is still seen as a reliable measure of weight for mos normal human beings and under 25 is the recommended target. However, between 25 and 30 is OK for more elderly people, say over 65. Bearing in mind BMI is sensitive to the ratio between muscle and fat, in older people a highish BMI might be because muscle loss effects the ratio rather than just a matter of excess fat.

Finally there was advice about reheating food. Generally OK but be careful with rice because the bacteria present, although can be killed by thorough reheating, may have produce toxic spore that are immune to heat.

Trust me, I’m a doctor web site.


Health and fitness – summary

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.