Cycling after Prostatectomy or brachytherapy

[Cowsham]

I hope all goes well with your treatment.

It's very unnerving for the doctor to mention the C word but I'm sure you'll be well after the treatment.

Please let us know how you get on with treatment and how you get on with cycling after it.

Many of us may have to go on the same journey.

[MikeF]

Why should it be odd? There are two main choices when eradicating prostate cancer. You either cut it out or kill it with radiation. Brachytherapy is a form of the latter

Surgery is drastic and a slight error could leave you incontinent or with other problems. It's not usually a first choice. It sounds as though your cancer is not severe and that is why you have been offered brachytherapy, but you should also have been offered external radiation as well.

Mike, I think maybe you are a little out of touch with Prostate Cancer treatments in 2021. The patient is given the choice to make; Radiotherapy or surgery. Radiotherapy for Prostate cancer is now carried out by inserting radioactive seeds in the prostate itself (Brachytherapy) not by external beam which relatively speaking is a scattergun approach. Prostatectomy (surgery) is carried out using microsurgery (via 5 holes in the stomach area) with a computerised machine called a Da Vinci. The surgeon does not wield the scalpel, he operates the Da Vinci on a computer screen from a remote position in the theatre. It is incredibly accurate and has revolutionised the surgery, which now carries approximately only a 5% chance of incontinence & it is the first choice for many people. My consultant was strongly in favour of it ahead of Radiotherapy. Radiotherapy of the prostate can cause bladder cancer, urine retention, cystitis and many other problems, often several years after what appears to be successful treatment. It burns the tissue, making further surgery a very difficult procedure, should it be required. It's a less invasive route initially but it carries quite a lot of unpredictable risk in the long term. Surgery is obviously much more invasive in the first instance but these days only requires one overnight stay in hospital. It also provides an assurance. If your prostate has been removed you can't get cancer recurring in it.

I researched the choices at length before I made my decision, aided by my daughter who is a surgeon. She and the majority of her colleagues were overwhelmingly consistent in recommending surgery ahead of radiotherapy and based upon the evidence and data, so was I.

Any form of cancer is serious and my cancer is a Gleason 3/4 b.t.w., which is at the turning point and going nasty.

I wish you well. It's worrying I know.
I know men who who have had prostrate removed by surgery and they are fine. They were aged about 60 when it was carried out. Surgery doesn't seem to be a preferred option for older men.

I would have thought brachytherapy is more of a scatter gun approach as it's just a radioactive implant.

The alignment for external beam is very precise.

My Gleason was also 3+4 in 6/24 cores. I also had a scan to detect if it had spread to other organs.

[saudidave]

Surgery is drastic and a slight error could leave you incontinent or with other problems. It's not usually a first choice. It sounds as though your cancer is not severe and that is why you have been offered brachytherapy, but you should also have been offered external radiation as well.

Mike, I think maybe you are a little out of touch with Prostate Cancer treatments in 2021. The patient is given the choice to make; Radiotherapy or surgery. Radiotherapy for Prostate cancer is now carried out by inserting radioactive seeds in the prostate itself (Brachytherapy) not by external beam which relatively speaking is a scattergun approach. Prostatectomy (surgery) is carried out using microsurgery (via 5 holes in the stomach area) with a computerised machine called a Da Vinci. The surgeon does not wield the scalpel, he operates the Da Vinci on a computer screen from a remote position in the theatre. It is incredibly accurate and has revolutionised the surgery, which now carries approximately only a 5% chance of incontinence & it is the first choice for many people. My consultant was strongly in favour of it ahead of Radiotherapy. Radiotherapy of the prostate can cause bladder cancer, urine retention, cystitis and many other problems, often several years after what appears to be successful treatment. It burns the tissue, making further surgery a very difficult procedure, should it be required. It's a less invasive route initially but it carries quite a lot of unpredictable risk in the long term. Surgery is obviously much more invasive in the first instance but these days only requires one overnight stay in hospital. It also provides an assurance. If your prostate has been removed you can't get cancer recurring in it.

I researched the choices at length before I made my decision, aided by my daughter who is a surgeon. She and the majority of her colleagues were overwhelmingly consistent in recommending surgery ahead of radiotherapy and based upon the evidence and data, so was I.

Any form of cancer is serious and my cancer is a Gleason 3/4 b.t.w., which is at the turning point and going nasty.

I wish you well. It's worrying I know.
I know men who who have had prostrate removed by surgery and they are fine. They were aged about 60 when it was carried out. Surgery doesn't seem to be a preferred option for older men.

I would have thought brachytherapy is more of a scatter gun approach as it's just a radioactive implant.

The alignment for external beam is very precise.

My Gleason was also 3+4 in 6/24 cores. I also had a scan to detect if it had spread to other organs.

Mike, Brachytherapy is putting the radioactive pellets directly in to the prostate, which is as precise as it gets! Scattergun it is not. The fact is that
radiation treatment in itself can cause cancers. Marie Curie died of cancer due to her exposure to it. My wife had 15 doses of radiotherapy after her breast cancer surgery eight years ago and the effect on her was traumatic. At the end of it she looked 10 years older than when she started. It's not a panacea, it's an absolute sledghammer to the system.

Surgery is an option for all prostate cancer patients who are physically capable of undergoing anaesthesia. Age is not the defining factor other than a team looks at your general health and lifestyle to callously consider if surgery is going to be a good health and economic trade off in your case. Additionally if you have surgery to remove the prostate and you need treatment after, due to the cancer having spread, then radiotherapy is then an option, but if you have radiotherapy then need surgery, then it's an issue. The tissue is literally friable & the surgeon has difficulty cutting it and stitching it & it is, I'm told very difficult to do as the tissue breaks apart

Robotic prostatectomy has revolutionised the surgery and has turned it from a procedure that was incredibly risky and almost certain to leave you incontinent and with erectile dysfunction to one with an extremely good outcome. It's been in use in the UK for 17 years now and my surgeon is one of the pioneers of it, so I couldn't be in better hands. After a lot of research, (a lot!) and listening carefully to the advice of several surgeons, they being my daughter and several of her colleagues including senior consultants, I've concluded that the odds of a good quality of life after surgery are now higher than after radiation therapy. I don't want to live with the possibility of side effects presenting themselves several years after radiation therapy as they can do.

[Glen]

Can anyone offer any words of wisdom based upon personal experience about either procedure and the relevant after effects please?

Hi,
I can also share some personal experience here. I had a radical prostatectomy in November 2019, aged 59. I tried my first ride just over 6 weeks later and had to get of the bike after 7 km because of the pain! A week later I was much improved and gradually built up the mileage. I started off using a turbo trainer; it’s much easier to stop a ride! I was back to normal fitness and riding my usual routes after about 3 months.

Obviously I was concerned about incontinence following surgery. I found that following removal of the catheter I was immediately dry lying down and mostly dry sitting, so cycling was OK. I was fairly conscientious with my pelvic floor exercises and was continent when standing and walking after 4-5 months.

I researched and pondered the relative merits of surgery and radiotherapy. I was advised that surgery following radiation treatment is problematic and that, long term, removal of the prostate is the least risky option. I feel fortunate to have had my treatment before Covid arrived!

Hope this helps and Good Luck.

[djnotts]

All very timely. Prostate biopsy yesterday. Presence pretty near certain (MRIs 12 months and 1 month ago).
All biopsy will do is judge aggressiveness and then I can decide on next steps, if any.
Surgery doesn't seem an option at my age/health. Radiation etc likely to be a "cure" worse than the disease.
Must be more difficult decisions if younger. Crucial to be an "expert patient" when discussing with medics.

[saudidave]

Can anyone offer any words of wisdom based upon personal experience about either procedure and the relevant after effects please?

Hi,
I can also share some personal experience here. I had a radical prostatectomy in November 2019, aged 59. I tried my first ride just over 6 weeks later and had to get of the bike after 7 km because of the pain! A week later I was much improved and gradually built up the mileage. I started off using a turbo trainer; it’s much easier to stop a ride! I was back to normal fitness and riding my usual routes after about 3 months.

Obviously I was concerned about incontinence following surgery. I found that following removal of the catheter I was immediately dry lying down and mostly dry sitting, so cycling was OK. I was fairly conscientious with my pelvic floor exercises and was continent when standing and walking after 4-5 months.

I researched and pondered the relative merits of surgery and radiotherapy. I was advised that surgery following radiation treatment is problematic and that, long term, removal of the prostate is the least risky option. I feel fortunate to have had my treatment before Covid arrived!

Hope this helps and Good Luck.

Glen, Many thanks for this response, it’s a great comfort as I am booked in for surgery, next Thursday March 11th. Your conclusions were exactly the same as those I drew and having spoken to around 10 others who have had RP, they were all continent within a few months at most. Sounds the best alternative to me.

[Dave R]

Best of luck on the 11th saudidave. I'm sure you'll be fine. They gave me a paracetomol and ibuprofen pill half hour before the op and assured me that's all the pain control i'd need. They were right, i felt no discomfort at all. I woke up 3 1/2 hours later and wondered what all the fuss was about. I was right as ninepence on the ward and walking to the toilet to empty the bag by the afternoon. One night in hospital and then home.
All that said be careful walking and especially upstairs. You will need to give yourself time.

[saudidave]

Best of luck on the 11th saudidave. I'm sure you'll be fine. They gave me a paracetomol and ibuprofen pill half hour before the op and assured me that's all the pain control i'd need. They were right, i felt no discomfort at all. I woke up 3 1/2 hours later and wondered what all the fuss was about. I was right as ninepence on the ward and walking to the toilet to empty the bag by the afternoon. One night in hospital and then home.
All that said be careful walking and especially upstairs. You will need to give yourself time.

Thanks Dave, that's another great reassurance. I've now spoken to, been told about or corresponded with around 20 blokes who've had this procedure and all have been good reports. Not so for brachytherapy. I have only a few reports of that but one in particular whom I know personally was fine for two years then got all sorts of problems including excruciating cystitis and trouble peeing. He's now on tablets for life with the latter and has repeated bouts of cystitis so I'm convinced my decision was the right one.

I'll be careful walking, I'll have too be as I've got a bad bout of sciatica at present and I'm far more concerned about that than the operation! Thanks again.

[djnotts]

FWIW, from what I have read then were I younger and healthier and thus be "offered" the choice it would be surgery.

Good luck, hope all goes to plan.

[saudidave]

FWIW, from what I have read then were I younger and healthier and thus be "offered" the choice it would be surgery.

Good luck, hope all goes to plan.

Thank you, that's most kind. I'm sure it will go to plan. The alternatives are brachytherapy or the wooden overcoat and I'm not keen on either of those. Given your predicament however, I'd go brachytherapy for sure. The odds overwhelmingly are that it will control or cure the condition without the horrendous side effects that can occur from it, it's only a small percentage that goes wrong. When all is said and done the COPD may not destroy your quality of life as fast as you think and if you're shuffling off your mortal coil with prostate cancer and you are still independent, then you'll be wishing you'd taken the Brachy route. Go for it and take care.

[djnotts]

Thanks to you also. I take your point, but I remain of the no treatment inclination. TBH I have lived long enough and an earlier rather than later departure in the kids' best interests.

[saudidave]

Well, I had the operation on the 11th and it was textbook stuff but sadly on the 12th I became unwell and to cut a long story short I collapsed with internal bleeding and required further surgery. The surgeons approximated my blood volume to be 6.5litres and they took 4.5 litres out of my abdomen meaning that I had only 31% of what I needed that was doing any good. I had a pulse of 148 as my body tried to push my B.P. up but it was sitting at around 75/50 with a haemoglobin reading of 46, from 120 the previous day. I was in deep trouble and shouldn't have survived it but somehow I di
I spent a further 48 hours in a medically induced coma and 4 more in intensive care but I'm out now and hopeful of a full recovery.

C'est la vie.

[Jdsk]

Sounds tough.

Best wishes for the future.

Jonathan

PS: Blood donors are always needed: https://www.blood.co.uk.

[djnotts]

That was bad - so glad you got through and my best wishes for recovery. You must be essentially strong to have survived.

Biopsy confirmed mine as Gleason 4 + 5, better than 5 +4! but bad enough. Surgery not an option, nor is brachytherapy. I have decided on and begun hormone medication in advance of external radiation - a course of action which I can of course end at any time should it prove counter-productive.

Still apparently all within the prostate, minimally invasive stuff might buy me a couple of years.

I'm churning out 120 miles a week while I can to keep as "healthy" as possible!

[saudidave]

Sounds tough.

Best wishes for the future.

Jonathan

PS: Blood donors are always needed: https://www.blood.co.uk.

It's been very tough and the only reason I've survived at all is my core fitness. With the stats I had during the op, most 68 yr olds could easily have died. My fitness is also showing through now in my recovery as I'm recovering at a massive rate. I walked 800m today, 6 days after being aroused from a medically induced coma. I'm rather pleased with my progress! The aim is back on the bike by 1st May.