Maybe, as an active cyclist you just like to keep yourself informed, or maybe, like me, you’re in the 50+ age group that seems to be the hard target for prostate risk campaigns in various media. Or maybe you’re directly affected by prostate issues or cancer. If so, you’re not alone. Stats for cancer show the prostate gland is the most common site for cancer in males in the UK and similarly among males in Australia, and second only to lung cancer in men in the US. What we’re interested in specifically here though is the role in all this that cycling plays for the fellas among us. Where do we start deciphering the research, the studies and the conclusions particularly in the tabloid straplines and clickbait headlines about cycling? Well since all science (besides my beloved mathematics) is nothing but repeatable and testable hypothesis, I don’t know how realistic it is to talk about sticking to facts only. There’s a degree of speculative conclusion from any studies no matter how large scale or with however many participants. The human body-mind is far too complex a web of interrelationships to be pinned down to one or more facile studies, which is why meds rarely come without adverse effects. Nevertheless, what’s it all amount to, this often reported “link” between cycling and prostate issues and prostate cancer moreover? Let’s have a look, Dear Reader, and welcome along!
So can cycling cause prostate cancer? During the course of my research, I’ve found that for every study that purports correlation, it seems possible to find another study that purports little or no correlation between the two. I’ll reference below. But as I’m sure we’re well aware, correlation in and of itself, is not causation. The conclusion I would draw is that in the absence of definitive evidence of cycling being a firm causative factor in prostate cancer, deference ought to be made to the weight of evidence for cycling having a beneficial effect on both the physical and mental health of cyclists, particularly in the higher-prostate-risk, over-50s group. I believe this ameliorating effect is hard to ignore. But let’s examine this in a bit more detail, and perhaps most importantly, ask what we, as cyclists can, or should do in the course of our riding to buffer us against any potential risk…
Firstly, what exactly is the function of the prostate gland anyway?
- The prostate gland is a walnut-sized organ in front of the rectum between the bladder and penis. Its main function is to secrete prostatic fluids. Prostatic fluids are alkaline and form part of the gent’s seminal fluid. One function of these fluids, being alkaline, is to protect sperm from damage in the acidic vaginal surroundings. It further functions to remove toxins that would seek to damage fragile sperm cells.
- Nerves within the prostate -referred to as potency nerves– are responsible for erections. This is why erectile difficulties and prostate issues such as enlarged prostate (BPH – Benign Prostate Hyperplasia) are interlinked. And further, the prostate is also a pump that assists in the ejaculation of semenal fluid. This pumping action is also partly responsible for male sexual satisfaction.
- Interestingly also, the prostate produces an enzyme that converts regular testosterone into the sexual drive and puberty onset hormone DHT – dihydrotestosterone. It’s understandable then that as we age as men, an accumulation of toxins in the DHT-regulating prostate can be jointly responsible for diminished libido. Makes sense, right? DHT is also itself involved in prostate growth, so it’s a cyclical thing. And not in a bicycle way! #dadjoke
So what are the main prostate issues and their suspected causes?
1. Prostate enlargement (Benign Prostate Hyperplasia BPH)
Q: What is prostate enlargement or BPH?
A: An enlargement of the prostate gland can cause urinary issues in men. The urethra – the tube through which urine (and semen) exit via the penis in men – passes directly through the prostate gland. It’s because of its route that an enlarged prostate gland has the effect of compressing the urethra. Because of this squeeze on the tube, the flow of urine can be impeded. Men can experience difficulty starting and/or stopping urinating, a weak flow of urine once it gets going, a more frequent need to pee which can sadly disturb sleep too, and a feeling of incomplete bladder emptying.
This is a very common problem, particularly in our at-risk group of men 50+. It’s clear though that there are no established links at all between prostate enlargement and prostate cancer.
Q: What are the risk factors and causes of BPH?
A: While it seems aging, previous family history, diabetes/obesity, and heart disease & beta-blocker usage are contributory risk factors for BPH nevertheless, and common or not, what it is that causes prostate enlargement isn’t exactly clear. But what I’ve seen suggested are the following…
- That the enlargement might occur due to imbalance in the sex hormones related to aging. Basically with age as men, the amount of active testosterone in our blood decreases leaving a greater proportion of oestrogen, the female hormone. So it’s theorized that the higher oestrogen within the prostate increases the activity of prostate cell growth substances. Interestingly, men who have had to have – as a result of testicular cancer – testicles removed when younger do not have any prostate enlargement, which evidences a link to testosterone or changes in the cells of the testes.
- The DHT hormone as mentioned above is also implicated, in what, for me at least is a counterintuitive idea. It’s that despite testosterone level drops, DHT (whose level has a strong direct correlation with testosterone level) continues to be produced in older men and can accumulate, causing prostate cells to continue to grow. I think that’s borne from the fact that men who don’t produce DHT don’t develop BPH. Not my place to theorize but I think it’s interesting particularly in relation to us as cyclists and testosterone levels during exercise. I’ll mention this in the next section 🙂
Q: What is Prostatitis?
A: Prostatitis is a frequently painful and often distressing inflammation of the prostate. It’s a condition however that usually eases off with time. Unlike BPH above which affects men in disproportionately higher numbers as they age, prostatitis affects a broad range of men of all ages. While urination symptoms are similar to BPH, prostatitis can also cause complete acute urinary retention – AUR. Understandably this can require urgent medical attention. Because of the prostate’s location in the body, its inflammation during prostatitis can also be responsible for causing soreness of the penis, testicles, anus, lower abdomen or lower back, both in general or when ejaculating or after sex. It can even cause painful passing of stools. So it can certainly be a job to live with all that going on.
With the exception of AUR mentioned above, prostatitis can be treated with antibiotics and/or painkillers, or alpha-blockers.
Q: What are the risk factors and causes of prostatitis?
A: Risk factors include urinary tract infections, having a history of prostatitis previously, and having an STI such as chlamydia or gonorrhea, amongst others.
In terms of the causes…
- Acute prostatitis is most often caused by a urinary tract infection where bacteria in the urinary tract enters the prostate.
- For chronic prostatitis, diagnosed when persisting more than 3 months, the actual causes are once again, not always clear. However, it’s suspected – and we cyclists can pay attention – that nerve damage to the perineum through trauma – yeah I’m looking at you on the svelte racing saddle! – or surgery, could be a contributory factor.
- Interestingly I’ve also discovered the idea of mental or psychological stress playing a role in chronic non-bacterial prostatitis. How so? Well it seems stress, besides being the silent killer we’ve all known at some point, is jointly, or maybe largely responsible for amongst other things pelvic floor disorders. Thing is, we know I’m sure when it comes to our mental health, that cycling is almost a panacea in that regard, right?
3. Prostate cancer
Prostate cancer is slow to grow and not, comparatively speaking, aggressive. When detected at the stage that it’s still localized within the prostate, it gives a very high rate of cure. The problem is that initially it doesn’t always make itself completely obvious to those who have it. This can allow it sufficient time to metastasize to other sites. It’s often the damage done at those other sites that can result in greater issues, even death.
Interesting to note, I find that while the highest incidence of prostate cancer is in North America, it’s lowest in South Asia. I’d also be interested to know what it might suggest, that there’s a positive correlation between incidence of prostate cancer and the Human Development Index figure (the composite index of a nation’s socio-economic development: life expectancy, education, income). Why might this be? Why might there be a lower incidence in Asia, Africa and Latin America than in the US and Europe for example? Better screening is suggested as a factor. It’s suggested too that perhaps in those countries, diets may contain more fresh fruit and vegetables and perhaps less non-beneficial fat. One interesting fact is that Japanese and African men, as citizens of their own countries have an incidence of prostate cancer that rises sharply upon emigrating to the US. What might that suggest? What do you think?
Q: What are the risk factors and causes of prostate cancer?
A: It’s more often than not cited that, besides what we’ve mentioned – aging (55-75 years), prior family history, and race factors, the risk factors for prostate cancer are not clearly established. Of positive note for us cyclists perhaps is the suggestion that, lack of exercise may be a contributory factor, as it is with many cancers. But then I think, as cyclists, we’re aware of the protective effect of exercise from cancers already, yes?
It has to be noted though, that cycling, like other endurance exercises causes the release of testosterone as a recuperative agent. And testosterone is known to speed the growth of prostate cancer. So does that suggest anything? Or not? I think it’s more likely that diet can play the bigger negative role in testosterone since diets high in meats and fats are known to increase testosterone. As a committed lifetime cyclist, I’m always going to take the part of cycling as being beneficial because subjectively that’s how it feels. Folk on crap diets ain’t doing themselves no favors. We all know that. It’s about responsibility.
There’s ample evidence to suggest that estrogen has a role in causing prostate cancer. Which brings me to the other issue with crap diets, and that’s the increased prevalence of estrogens in those self-same factory foods, commercial meats and dairy. Obviously this, competing as it does with large, well-bankrolled agri-commercial interests, it’s often reduced to speculation. For me though, most worrying, and one which seems to circumvent cyclist health and awareness is that idea that oestrogen could be finding its way into the municipal drinking water. Entering the sewage system from female contraceptive pill usage, estrogen isn’t filtered at water and sewage treatment works meaning estrogen levels could theoretically be elevated even in our drinking water. Again, if that were true, would we even know #conspiracytheory101 😀
How might cycling conceivably contribute to those causes?
Is there even any link at all? Some say yes. This “men who cycle more than 8.5 hours per week…” study got a lot of media traction a few years back. Other sources have given a perhaps more level-headed analysis of what appears a flawed study. A balanced take on the study is here. And also here. Most balanced takes understand the huge positive impacts cycling has on riders’ physical health and take individual studies in light of this long established fact.
Okay, I’m not going to dwell on this too much because personally I’m not feeling it as being an argument with much bite. I mean intuitively the non-cyclist might indeed conclude…
Oh, it’s all that banging around trauma to the pelvic floor area from the saddle, that’s what causes cancer there!
Haha, I don’t know who that sanctimonious person was. But anyhow, yes, there is some evidence to suggest that perineal trauma from poor posture, saddle position or saddle choice can potentially contribute to inflammation of the prostrate and/or prostatitis. What the aforementioned anonymous naysayer might advance then is that it’s a short hop from that repeated prostate trauma to cancer. Okay maybe. But it’s a leap that I feel, to my layman’s understanding is almost unbridgeable without a lot of support that doesn’t exist anywhere I can find. Can you??
But then again, we ourselves as cyclists could well evidence that spurious notion. Why? Because we all know or likely have personal experience ourselves of that numbness through the perineum and think it logical to conclude with others that cycling is bad for our pelvic floor region (and could well lead to more serious effects). But what’s happening is that trauma to the perineum causes inflammation that compresses the pudendal nerve which routes through the midst and that compression creates the numbness. But the thing about numbness – the kind that can also provably lead to erectile dysfunction – it’s a user error!
Yes! It invariably comes down to one or more of three things. Either your saddle is just wrong for you. And I know from experience what a job it can be to find the right pain-free saddle fit for any of us. Or your saddle position itself requires adjusting, be that tilt, fore-aft, or seatpost height. Or your own position needs adjusting. That transient numbness, be it a few seconds or a few days is your body’s call for help! Please don’t ignore it 🙂
So here’s what I propose. In the absence of any irrefutable evidence (or as near to) providing both a strong link between cycling and prostate cancer, and a verifiable cause I think we’ll have to make our own hypothesis based upon the educated hypotheses of others. Why? Because then, as cyclists we can take our own preventative actions should we see fit.
How do we, as cyclists mitigate against our cycling as potential causes of prostate issues?
Well there’s no conclusive link between cycling and prostate cancer. We know cycling is healthful. You only have to be a cyclist to get that. It couldn’t be more obvious. Long may we all have health to keep riding I say! #canigetanamen?
Nevertheless, there does seem to be some correlations between how we do our cycling (as opposed to cycling per se) and prostate enlargement, prostatitis and erectile dysfunction. So the questions is, what do we do about that?
To my mind, the main link, both literally and metaphorically between cyclists and prostate issues is our bicycle saddle. If it wasn’t for the saddle, we’d just be men, exposed to no greater nor lesser risk of prostate issues than any other men in the general populus, right?
Do you ignore saddle trauma?
Please, please don’t! I’ve already described at length my saddle issues. Although these primarily concerned sitbone pain, during the course of my seemingly never-ending saddle trials, I discovered a saddle that, while it helped somewhat with the sitbone pain, it did ENTIRELY eliminate the perineal numbness. I haven’t had a single moment of numbness at all on any ride since swapping to this saddle.
Now I’m not advocating for this saddle in particular. I’m not suggesting this saddle is any kind of panacea. I know we’re all far too differently constructed as individuals for that. What I am suggesting however, is that you keep investigating saddles with the specific goal of eliminating ALL numbness. Don’t give up on that search! Your prostate health in the long term (or immediate future if you’re in my age group!) is too important to! To that end, I’ve collated a few of the more, shall we say, interesting saddle choices specifically for perineal numbness that might inform your research. But briefly for now…
Saddles without peaks and valleys
In all my saddle trials, I think I concluded that the problem is with any saddle whose shape rests any significant proportion of my bodyweight on my perineal area. For me personally, saddles with a flat profile are out. Saddles with a convex upper across the top from flank to flank are also out.
Likewise, for me personally the swoopy Charge Spoon / Fabric Line are also out. Why these? Because my sitbones aren’t being isolated as weight-bearing points and my weight is being partly taken on the perineum. For me it was the stepped shape of the SQLabs saddle that completely alleviated ALL numbness symptoms. It was an absolute revelation. But a quiet one! One that you don’t notice until you notice! Especially on colder days when it was always noticeable! #tmi 😀 But the same beneficial effect can be realised according to a study in the British Journal of Urology International in 2007 (99:135-140) by using channeled saddles, or grooved, or hammock-style saddles or, dare I say it, noseless saddles. Anecdotally the super-cradling saddle from SMP, the Strike, I found very helpful in this regard. Yes, a bit of an ugly duckling perhaps, but then hey, you’re sitting on it, nobody’s looking there! 😀
But it’s not just about the right saddle. It must be the right saddle for you in the width that suits the measurement across your sitbones. If you don’t know, this isn’t difficult to do with some corrugated card or aluminium foil etc. And why’s this important? Because if the saddle is too narrow for your particular sitbones, those contact points may be too low on the convex edges. So while the saddle might be a good choice for you, being too narrow means your perineal area will be bearing part of your weight!
What about your riding posture?
I found an ideal position using a simple kind of bodily mindfulness as described in my saddle and sitbones article, that isn’t difficult to find, if you’re not already there. The correct ride positioning and posture only helps, of course, if your saddle isn’t working against you. So saddle first, posture second.
I don’t need to mention reducing the other suggested risk factors for prostate issues because firstly, I think as cyclists, we’re a fairly health-conscious bunch on the whole. I mean sure, who doesn’t like a cream bun or donut at cafe breaks or whatever, but eating crap isn’t what most of us spend our time doing, is it? I’m no health nazi but I doubt I’m alone in that, right? I’m looking for confirmation here!! lol 😀 Ironically I think we already have most of the health bases covered from actually doing cycling!
I want to make one last point that I think is interesting. It’s been an educated conclusion of mine for a long time and I’m pleased to see there’s some evidence to support it. Without being indelicate or wanting to offend your sensibilities (lol) it’s that the frequency of ejaculation, while not a preventative measure(!) seems to be associated with a reduction in risk of prostate cancer. I think to my mind at least that ties all the strands nicely. Why, for example, prostate cancer has a far greater incidence among men over 50. I think it’s well summarized by the the use it or lose it aphorism. That’s possibly not the most alluring chat-up line to present to your sexual partner, but hey, it’s food for thought, right? 🙂
So in conclusion, toptube descents are out! Haha, just kidding 😀 Or am I? Maybe just for our own safety let’s not! It’s no faster you know that don’t you? 😛
But no, I’m going to repeat what I’ve said and urge us all to keep riding. But to do so mindfully of what our body might be telling us. Or yelling at us! I don’t need to tell any of you how amazing cycling is for feeling a sense of physical and mental wellness. It might be wholly subjective, but it’s indisputable by those of us who do. And I think if it’s that wellness we manifest (as opposed to the fear instilled in these half-baked studies) then it’s wellness we’ll have. So ride on and I’ll see you all there.
Have fun meantime, ride safe, and ride comfortably, David.