July 2017 blood test

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.

How Exercise Might Reduce Prostate Cancer Progression

“A new study suggests that vigorous physical activity will offer protection against prostate cancer progression because of its effects on DNA repair and cell-cycle pathways. The finding might help explain previous observations that men who exercise vigorously have a reduced risk for all-cause mortality and prostate-cancer-specific mortality”.

“Men who reported that they undertook vigorous physical activity for 3 hours per week or more were found to have a 49% lower risk for all-cause mortality and a 61% lower risk for prostate-cancer-specific mortality than those who exercised for less than 1 hour per week. The vigorous physical exercise consisted of jogging, cycling, tennis, or swimming. Men who reported this type of exercise for more than 3 hours per week before and after their diagnosis of prostate cancer had the lowest risk for all-cause and prostate-cancer-specific mortality”.

http://www.medscape.com/viewarticle/757935

Prescribing exercise

I’m currently doing a Future-learn free course on the use of exercise to treat diseases and conditions of various sorts https://www.futurelearn.com/courses/exercise-prescription. This is of particular interest to me due to my general concern to keep fit and healthy and ward off possible heart disease in the future but also as exercise may also inhibit the development of my remaining cancer. I also have a very dear friend who is currently recovering from a quadruple bypass operation to deal with her heart condition and am keen to see if there is anything I can do to help her recovery. The course is for health professionals who are interested in prescribing exercise for their patients. Reading some of the materials it is clear that exercise can be potentially dangerous for some heart condition patients and should be prescribed with great care. Any activity is better than no activity even in these cases but it is imperative not to overdo it. There are ways of assessing an individual’s readiness for exercise and it will be important to listen to the consultant’s and physio’s advice. I think it is normal these days for heart patients to be put on a supervised exercise programme, as was my brother-in-law after having a couple of stents inserted. What will be important is keeping an appropriate level of exercise going after the programme (coupled to any dietary changes needed). The problem here is likely to be motivation, an area where friends and family can definitely help.

6 week post-op update

It is nearly a month since I last posted and nothing much has happened. I’ve made quite good progress largely through walking although I’ve picked up the pace a bit with racketball.  I started coaching again from Thursday 8th September and returned to doing full Monday and Thursday sessions from Monday the 19th. This was 4 weeks after the operation. I warmed up gently in the gym rather than on court with the other players and did some of the less physically demanding practice routines with them. When it came to playing matches I stayed on the court where we had 4 playing in rotation (so plenty of rest time) and didn’t chase anything, limiting myself to hitting balls that were within a step or two to reach. No twisting and turning and rapid changes of direction. I felt pretty good and knew I was taking it easy as I had no leg aches and pains afterwards, normally a sure sign I had been pushing myself. Last Thursday (29th October) I did the club training evening with our coach, Saeed, and pushed a bit harder. I had done the morning U3A session too with a bit of coaching but had taken it very easy. But by the time Thursday was over my legs were pretty sore so I knew I had been pushing myself round the court a bit harder. The Thursday evening sessions are harder as the players who attend regularly are all pretty good and serious players.

Since the beginning of the month my weight has gone up and stabilised around 12 stone 10 or 11 lbs and, as I write this, I have a bit of a chest and throat cold. This has kept me in doors for the last couple of days but today, a cool but bright and sunny day, I did a 5 mile walk along the canal and am beginning to feel better.

I’m going to see Mr Singh, the consultant, on Thursday this week to hear the results of the tissue tests and the blood test I had done at the BRI Thursday last week. This is when I’ll find out if there is any evidence of cancer in the surrounding tissue and whether I will need radiotherapy or any other further treatment.

The walking cure

On Wednesday 31st August, the day after my catheter and staples were removed, I started a walking regime to help me get as fit as quickly possible. It is now a week later and since then I have met the steps target set me by my Vivofit everyday. While I continue to hit the target the Vivofit increases the step target each day. Last Wednesday this was 7728 and by Tuesday 6th September it had increased to 9347. Over the week I walked 82,912 steps, an average of 11,845 per day, about a 5 mile average. Walking was the only form of exercise that was recommended for the first few weeks with no further instructions other than to “listen to my body”, which I did. Towards the end of the week I started to incorporate a few hills. I’ve been very happy with the way it’s gone and feel significantly better now than I did a week ago. More of the same for another couple of weeks I think although I will not be particularly worried if I don’t meet the targets set every day from now on.

I went to the squash club at Heaton on Thursday 1st September, 11 days after the operation, and had about a 10 minute knock by myself to see how it felt. I didn’t push it at all, just hitting to myself down the side walls in the channels and some figure of 8s at the front to minimise my movement and not damage myself. I felt fine with no twinges. I did the same again on Monday 5th with the same result. I will start going regularly to build on this but it will be a while before I play against an opponent, even socially. Thursday I should be able to return to doing a little coaching as before. My weight has stabilised at around 12 stone 9 or 10, about 6 lbs lighter than when I went in for the operation so my strategy to not put on weight seems to be working so far.

With a view to starting cycling again I have been researching saddles with a cut-out to relive pressure on the perineum. Normal saddles put pressure on this area and can be quite painful for quite a while after a radical prostatectomy as this bears directly on the area where the urethra has been joined up. This gets better over time apparently. I probably won’t ride until I’ve seen Mr Singh and I may need to know if I should delay until after radiotherapy if that is needed.

I have spotted on a couple of occasions a very small blood clot being passed in my urine but have decided not to worry about it. I have 4 weeks before my scheduled appointment with Mr Singh and the BRI (when I will get the histology report and learn if I need radiotherapy) and will mention it then if it continues.

Prostate cancer and excercise

There was a news item on the BBC Today programme Thursday last week on some research being done on any possible connection with exercise and the speed of development of prostate cancer in men that have been diagnosed with a Gleason score of 6 or 7 and on active surveillance. This is the PANTERA study. Details of the study and how to volunteer to be a subject can be found on the Cancer Research website. I fit the criteria to join the trial on every count except I already exercise beyond the maximum specified in advance of the study, more than 90 minutes per week of moderate intensity exercise. However, I was sufficiently interested to contact the lead researcher, Liam Bourke, by email. I asked if there if there is any information on the exercise regime required of the supervised group and whether they will be given any advice on nutrition. I was also interested in the conduct of the trial, in particular how if at all the ‘self-help’ group will be monitored for any level of activity they may decide to adopt in the light of the information pack you will be giving them and what that information pack consists of.

Dr. Bourke’s reply contained details of the exercise regime: Participants will be asked to attend two group-based supervised exercise sessions a week, comprising up to 45 minutes of aerobic exercise. Exercise intensity will be 65% to 85% of age predicted maximum heart rate or 12 to 17 on the Borg rating of perceived exertion scale, in episodes of 20-30 minutes of continuous exercise for the first 8 weeks, progressing up to 45 minutes per session thereafter. Gym based aerobic exercise training will be conducted using standard ergometers e.g. stationary cycles, rowing ergometers or treadmills. In addition, men are required to undertake self-directed two exercise episodes of up to 30 minutes per week, using an exercise log book and heart rate monitor to objectively record independent exercise behaviour and support adherence and compliance. They won’t be providing any nutrition interventions. The care pack for subjects in the group not undertaking regular supervised sessions is the standard Macmillan move more information pack, available free from McMillan Cancer Support. This comparison group’s exercise behaviour will be checked via standard questionnaires and any change in fitness by sub-maximal treadmill testing.
I have now joined the gym at my squash club and aim to replicate the 2 supervised sessions a week 20-30 minutes for 8 weeks and thereafter building to 45 minutes. I will not do the additional unsupervised sessions of 30 minutes per week as I think I will already be doing enough with cycling, walking and racketball!

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.