Running Prostate Cancer Away
This is about my experience of prostate cancer as a runner, in particular preparing for and recovering from surgery (a robotic assisted laparoscopic radical prostatectomy) and returning to running. My contribution is less about the medical procedure and more about my experience as a keen runner discovering that I had prostate cancer. I’ve appreciated hearing about others’ experiences while I’ve been going through this, and so I’m writing this primarily to support runners like me who are facing prostate cancer and are keen to remain active and fit.
There are obviously good reasons to be acutely aware of the dangers of prostate cancer: The notion that ‘men tend to die with prostate cancer rather than from it’ can be fatally misleading, and leads to complacency: prostate cancer is a killer especially if it develops in ‘younger’ men (I would include anyone in that category who considers that they still have active years yet to live). As Cancer Research point out: ‘In males in the UK, prostate cancer is the second most common cause of cancer death, with around 11,300 deaths in 2014; equivalent to 31 deaths per day’ (http://www.cancerresearchuk.org/). The absence of obvious symptoms is another of the reasons it is so dangerous: as a 60 year old I was fit and running well enough to win my veteran’s age category fairly frequently in local races, with the cancer having no affect whatsoever on my performance. Having to visit the bathroom at night was my only symptom. My father, despite also being fit and active, had presented late with prostate cancer, and it was found to have spread, and he had to undergo debilitating surgery and hormone treatment, from which he only temporarily recovered. As a consequence of his experience I had been undergoing regular PSA tests since my late 50s, and I was determined to be vigilant rather than suffer his fate. I was diagnosed with cancer in February 2017, age 61, following a PSA test, an ultrasound scan and a biopsy, and I opted for a radical prostatectomy, the complete surgical removal of the prostate, an option since all the cancer appeared to be contained within the prostate.
There are two consequences of radical prostatectomy surgery that troubled me greatly: the first was the prospect of incontinence, the second the curtailment of my running for an extended period. In order to diminish the magnitude of either of these I decided to use the months prior to my operation to become as fit as I possibly could. My fitness constituted three dimensions: running as much as possible, Kegel exercises, and yoga. The running would be the main contributor to my aerobic fitness; the Kegel exercises were to strengthen my pelvic floor in order to increase my chances of regaining my continence post-op, and the yoga was for my flexibility and overall well-being – and to help me reconcile myself to my new and unwelcome condition.
The diagnosis had an odd effect on some of my friends and wider family when they first heard about my having cancer. I remember going to a restaurant for a relative’s birthday celebration where one person hurried over and offered me a comfy chair, going to some trouble to see that I was comfortable, as if I might expire at any moment. I didn’t have the heart to mention that I had been intensively training for several weeks and was racing in the Yorkshire Three Peaks Mountain Marathon the following morning! After that I tended to avoid the word cancer when other people asked about my health, and to simply say that I had to have some surgery; I found most people assumed it would be treatment for a running injury, unless they inquired further. Later I became more accustomed to the fact of having the cancer myself, and found it easier to talk about it and to reassure people – and also I realised that I had a responsibility to raise awareness, as others had done with me.
My 2017 running schedule featured four major events: the Yorkshire Three Peaks race at the end of April, the Excalibur mountain half marathon in May, a Lake District expedition in June, and the Snowdon International Race in July. Being fit enough for each of these would entail a lot of running in any case, and I had done each before, some of them several times. This year I decided that not only would I accomplish all of them, but that I would train sufficiently hard to run them all the better than I had previously. As will become clear, I didn’t quite manage all of this, but I have no regrets about trying.
Here I am, on the left, in full flight at the final stage of the Llantysilio fell race,on a beautiful morning in March 2017, a month after the biopsy and diagnosis, and four months before the surgery. At this stage I was determined to run as much as my time and my legs would allow, with the idea of being as fit as possible when it came to my operation.
I have been running for many years, and I enjoy running all surfaces: road, cross-country, trail and fell, but it’s the latter that really inspires me and where I get most of my enjoyment. However, and perhaps ironically, I’m probably a better road runner than I am hill runner these days, as with age my ability to ascend steep hills quickly has diminished a little, whereas my pace and endurance on the flat is holding up well. Nonetheless, most of my training and most of the races that I do are in the familiar hills and mountains of North Wales and the Lake District,
Since all of my milestones were hill races, I devoted as much time as I could in March and April to running in the mountains, using the Clwydian hills as my training ground. I walk these hills regularly with my partner, who was to provide the most unstinting support and love throughout the whole period. It was to be my great good fortune to have such unconditional support from her and our family, even when my obsession with running got the better of me, which it did from time to time. I’m also fortunate to belong to a great local running club, Pensby Runners, who not only do regular training sessions but also have a hill running contingent who organise and support a fell running league. It’s worth mentioning that the support and encouragement of the club was a very significant factor in enabling me to come to terms with my illness and to remain positive throughout. Other members of the club had experienced prostate cancer and its various treatments, and their advice and support was invaluable.
I entered as many races for the club league as my work commitments would allow, and trained accordingly. Prior to the Three Peaks Race I ramped up my running mileage to over a hundred miles a month, which I optimistically hoped to maintain right up to my prostatectomy operation in July. This running schedule was complemented by my daily dog walks (c.30 miles per month). Meanwhile I commenced my Kegel exercises daily: these are simply the repetitive clenching and releasing of the pelvic floor, but I didn’t find them easy to do at first – identifying the nature of the exercise was the greatest challenge. I have since read the many men find it very difficult even to identify the pelvic floor muscles. However, once I’d got the knack I started to do them regularly. I found it helpful to align the exercises to my daily routines; I would do them while I was driving, using speed restriction signs as markers, clenching between some while releasing between others. This became so ingrained that I continue to do so whenever I get in a car, even when I’m not driving. I wasn’t sure if this was going to pay off, or if it would do anything at all, but I now know that it was significant in the recovery of my continence.
My yoga continued on a weekly basis. I’d only been doing yoga classes for about a year when I received my diagnosis, I was very grateful that I had. Whereas I tend to be a fairly decent runner for my age, I am inflexible and awkward when practising yoga. My partner is the opposite in both respects: she grumbles about her running (although she’s actually pretty good at it) but is graceful and poised on the yoga mat. I have found unexpected benefits for my running arising from my yoga; the way of thinking that I have been taught has helped me deal with the anxiety and distress that follows a cancer diagnosis, and enhances the peace of mind that follows long runs.
The Yorkshire Three Peaks race was both a triumph and disaster. A triumph in that I completed it and my time was better than the previous year (4hrs 50min), but a disaster in that I fell over twice coming off Ingleborough, and the second time hard enough to injure my leg and chest; neither stopped me completing the race – I was only a couple of miles from the end and determined to hobble in within a reasonable time – but they did enough damage to drastically curtail my training schedule afterwards. I managed to do enough to get round the Excalibur race three weeks later, but my time was worse than in previous years, and I wasn’t in great shape at the finish. The injuries also meant that the Lake District event in June had to be cancelled. However, I recovered and regained form towards the middle of June, which was just as well considering that there were only a few weeks to go before the Snowdon race – and my operation.
During the month before the operation I found myself dwelling negatively about what might happen to me; I was pretty scared at the prospect, and it cast a shadow over the routines of my ordinary life. The Snowdon race was a great help in this respect, occurring as it did four days before the operation, as simply accomplishing the course, a relentless five mile uphill slog to the 3,560ft summit from Llanberis followed by an exhilarating but tricky descent, lifted my spirits and my confidence. The fastest runners completed the whole race before I could even get to the top (which took me one hour and nine minutes), but I didn’t let this trouble me; on the contrary I was just delighted to be there and to have accomplished it.
The night before my operation I went on a nine mile club run, partly because I knew I wouldn’t be able to run again for some time, and partly to subdue my terror. The following morning I presented myself at 7am at my local hospital, and promptly fainted within 10 minutes of arriving as a nonplussed nurse attempted to take a routine blood sample. I should explain that my resilience as a runner deserts me in hospitals, and I was probably exhausted too. Thankfully a merciful anaesthetist suggested that I should be put under general anaesthetic sooner rather than later, as by this time I was feeling thoroughly wretched.
The next thing I was conscious of was waking up after my three and a half hour operation, although for me it only seemed as if a few minutes had elapsed. The robot assisted-operation seemed to have been a success according to the assistant surgeon. The morphine had put me into pleasant stupor, although I was emotionally overwhelmed, especially when my partner arrived shortly after I recovered consciousness. I had to stay in hospital one night for observation, and for most of the following day, which seemed like an age. I didn’t sleep much, mainly because of anxiety and the effects of anaesthetic. In the morning I was encouraged to get up and walk straight away. My belly was swollen due to the gas they to pumped into me to make room for the robot to work, and this pained me when lying down especially. Nevertheless I showered and dressed, and at tea-time I was ready to be collected and taken home. The care I received throughout was marvellous, and the nurses were very encouraging and thoughtful beyond the call of duty.
I had been fitted with a catheter, which I quickly learned to despise. More than anything else, it was the catheter which felt uncomfortable and restricted my movement, on top of the sore swollen belly. I also had to have my trousers and underwear creatively adapted (my partner is a textiles wizard) to accommodate a huge belly and to give easy access to the catheter bag. However, over the next few days I learned to move more freely and even to grow accustomed to the catheter – using lubrication and being fastidious about cleaning it helped greatly. I was constipated at first, which is an anticipated effect of the painkillers, and I discovered that frequent walks around the garden combined with lots of fruit, vegetables and liquid based foods solved that problem as did a higher ‘booster’ toilet seat which took away some of the pain of sitting and standing. I those first days slow walking was actually more comfortable than sitting or lying down.
At first I was wary of going away from the house, overtaken by waves of intense melancholic emotion, and rather embarrassed at my incapacities. I did eventually venture out, at first walking gingerly up the road with my partner and the dogs, and then gradually further afield. I started to enjoy going out, and everything in the world seemed to grow brighter as the first days passed by. About five days after the operation I visited an art exhibition at Port Sunlight, which was my first proper outing, and managed to enjoy the afternoon and engage with the pictures and forget my troubles for a while, overcoming my fear of wearing a catheter in a public space.
After a week I had the catheter removed. Despite hating the thing I’d also been dreading this moment, since this would also be the moment when I discovered how bad my incontinence was going to be. My fears prove unfounded, however, and even by the end of the first day my system seemed to reset itself. I now realise that the combination of months of Kegel exercises and my overall fitness were paying off. Within twenty four hours I was wearing normal clothes and underwear with light-use pads, and being teased about exchanging ‘nappies’ for ‘big boy pants’.
At the time of writing, four weeks after the operation, I still have to wear light pads (no big deal) for ‘stress incontinence’ (leakage through sudden movements or sneezing etc.) and I need to get up in the night every three hours or so, although I expect this to improve with time. I have the odd accident, but I do the Kegal exercises every day to help with this. I’m still feeling fragile and I’m careful not to lift anything heavy, but I’m out and about and interacting with the world, and driving again. I walk every day with the dogs – now I’m up to two and a half miles at a fairly normal walking pace – my first walks were very slow due to fatigue and discomfort from the wounds in my abdomen. The soreness is gradually subsiding, and I find that I can walk, sit and sleep in more comfort. I volunteered for marshalling at my local Parkrun, which proved to be a great idea, as it enabled me to do something useful at the same time as getting involved with running again.
I’ve learned that the best way to overcome the feeling of helplessness that arises from the disease and from being subjected to medical processes is to emphasise the things that I have complete control over: my fitness and how to fill my days. Prior to the surgery I became as fit as I could possibly hope to be, and ensured that I spent as much time as I could doing the things that I find most rewarding: spending time with my family and friends, upping my running, being in the hills, yoga, gardening, dog walking, drawing, reading, writing and playing music. In all these things I have agency, whereas I had none with cancer. Post-surgery I have continued to do these things where I can, and one by one reintroducing them as I’ve gained strength – in particular I’ve encouraged visitors or visited friends, and greatly appreciated their company.
I have learned to do more about the things that I could, and tried to worry less about the things that I couldn’t. I’ve had some encouraging role models in this respect, since there were others at the running club facing similar or more severe tests with cancer. Their determination to improve the quality of their lives through running and fitness has been a great source of inspiration to me.
I intend to write again in a few weeks time on my return to running and my progress with my fitness. In the meantime, I recommend and John Quigley’s ‘Running with Prostate Cancer – my Journey’ at: http://prostaterunner.blogspot.co.uk/2008/