Nick Dinsdale's biggest battle

SINCE June 2013, Nick Dinsdale BSc, MSc. has contributed many invaluable articles about the technical side of cycling.

He has an impressive C.V., both competitive and academic, and in the early 1990s worked as sports therapist to the GB Cycling team; he has carried out academic research into the foot/pedal interface; is a centre of excellence when it comes to bikefit; won the national CycloCross title in 1994 and in 2013 won the National UK Duathlon title (age-group 55-59) at 59 years old; he is also the proprietor of the NJD Sports Injury Centre.

In April 2018, Nick was diagnosed with stage 4 (aggressive) prostate cancer and, whilst undergoing extensive treatment and beyond, still managed to continue racing duathlons, including some iconic European events.

Nick’s inspirational story should encourage many of us to take a look at ourselves to see what makes us tick, and help provide us with coping mechanisms should we find ourselves in similar situations.

Below Nick details his recent battle against cancer. It contains information about his own personal experiences, the trials and tribulations, the positives and other important observations from this on-going journey:

The purpose of writing this article is two-fold. Firstly, to share my personal experiences with fellow cyclists of being diagnosed then competing with prostate cancer, including the associated ups and the downs. Secondly, to promote awareness of prostate cancer among fellow cyclists, its growing prevalence, unreliability of associated diagnostic tests, signs and symptoms and what to be aware of.

My diagnosis was wholly unexpected

Aged 64 years old, fit, supposedly healthy and competing in cycle and duathlon events across the UK and Europe, my life was completely turned upside down when I was unexpectedly diagnosed with prostate cancer in April, 2018. It came as a complete surprise, especially after my insistence on regular annual prostate check-ups (PSA) – alas, all of which proved not only to be a complete waste of time – but devastatingly misleading. PSA unreliable as standalone test

Although for some years leading up to my diagnosis, I was known to be symptomatic my regular PSA checks were found to be normal. Consequently, I was continually being advised that I simply had an enlarged, but healthy prostate. Only after a MRI scan, which incidentally I actually instigated, was I diagnosed. Importantly, yet unfortunately for me, my PSA did not reflect my cancerous condition. PSA represents a man’s prostate specific antigen. Through this article, I have the opportunity to promote the crucial awareness of the disease and to also inform fellow cyclists of the unreliability of stand-alone PSA tests.

Prevalence

Current statistics show that one in every eight men will be diagnosed with prostate cancer, also approximately 7% of men tested will present with unreliable PSA readings – similar to myself. In the UK, prostate cancer kills more people than breast cancer with around 50,000 new diagnoses every year - about 130 every day. As mentioned above, awareness is crucial in early diagnosis of prostate cancer despite the unreliability of standard PSA checks.

Cycling and Prostate issues Although there is weak evidence that trauma and repetitive compression from bicycle riding can irritate the prostate and could exacerbate, and perhaps lead, to prostatitis (inflammation of the prostate), there is no clear evidence to link cycling with prostate cancer. However, it is known that cycling may transiently increase your (PSA) level. Therefore, discuss with your doctor – who may request you avoid cycling for a short period prior to testing. A particular approach to reduce prostate issues such as repetitive compression is to use saddles with a groove or cut-out down the centre of the saddle aimed at reducing pressure on the perineum (sensitive under-carriage), including the prostate.

Signs and symptoms Unfortunately, signs and symptoms of prostate cancer are very similar to those of benign prostate enlargement (BPE), which is the medical term to describe an enlarged prostate – which approximately 50% of all men aged 50+ years will suffer from. By the age of 70, almost 90% of men will suffer from BPE. These include frequent visits to the toilet, especially at night; sudden urge to pee; weak flow, unable to empty your bladder; your bladder always feels full, even after visiting the toilet. Consequently, owing to the similarity in signs and symptoms, it can be difficult to differentiate between cancer and BPE, especially when PSA levels are unreliable – as in my circumstances.

My life changing experience Returning to my own personal circumstances, as one can imagine, cancer is an extremely unpleasant disease – which can reap both physiological and psychological devastation if not controlled. When first diagnosed I became very emotional… I was now facing a lifechanging experience. Initially, all I could think about was survival; thereafter quality of life – would I ever cycle again - never mind being capable of competing again. Instead of dwelling on it, I quickly decided that I had to confront my cancer head-on and move forwards swiftly and proactively.

My essential family support Life should always revolve around a sound, closely knit family; it certainly does with me and our family. Without my family, especially my wife Carol, who was also receiving extensive cancer treatment at the same time, coping would have proved immensely difficult. Serious illness generally adversely impacts on all family members, thus a united front with all round support is imperative. Treatment plan Fortunately, I was offered maximum treatment exposure, which is not always the case, dependant on age, physical condition and geographical location. I am also fortunate to have a daughter and son-in-law who are both doctors and continually checked my medical records and treatment plans against NHS Gold Standards to ensure I was receiving the best available treatment.

My treatment involved four months of maximum chemotherapy followed by a three month recovery period, then 37 days of radiotherapy, which represents the maximum exposure period.

Additionally, I started three-monthly injections of hormone therapy (androgen deprivation therapy (ADT)), which will continue for approximately three years – timescale is based on high risk cancer patients. Medium risk patients generally receive it for 4-6 months. Simplistically, the purpose of the hormone therapy is essentially to block or lower the amount of testosterone in the body – because testosterone fuels and promotes the growth of prostate cancer. Like other cancer treatments, hormone therapy is accompanied by a wide variety of very unpleasant side effects. For athletes, it leaves you fatigued and lowers physical performance as well as reducing bone and muscle mass.

In the next instalment of Cycle Clips Nick talks about fighting cancer in the mind as well as clinically.