Cycling and Prostate Cancer

By Russ Hoverman, M.D., Ph.D. – September 1, 2014
photography by JD Swiger

My cousin, a prolific steamy romance novelist, often refers to “nether regions” in her books. Technically, that’s the perineum, that area between the pubic bone and the coccyx front to back, and the “sit bones,” the ischial tuberosities, side to side. 

Just beneath the surface of the perineum are the nerves and blood vessels that supply the scrotum and penis of men and the labia and clitoris of women. A little deeper in the perineum in men is the prostate gland. 

For avid bicyclists, it’s an area of special concern because it’s what makes contact with the middle of the bike saddle.

Reports of health risks from cycling are not new. A 1997 Bicycle magazine article and a personal report from a cyclist training for the Race Across America proposed that prolonged cycling could lead to impotence and infertility. While most cyclists have had occasional episodes of perineum numbness, the association of sexual dysfunction with cycling has not been definitively proven.

A recent Journal of Men’s Health article examined a new study from London, which found a correlation of hours of cycling each week to the incidence of prostate cancer in men over 50. The study involved a self-reported response to an online survey appearing in UK cycling magazines. With 2,027 qualified surveys, researchers found a positive correlation of hours of cycling each week with the self-report of prostate cancer. In other words, the more cycling, the more reports of prostate cancer. This was particularly evident in those who cycled more than 8.5 hours per week. 

While this is the first known association of cycling with prostate cancer, any direct causal relationship is speculative. It is likely that the prostate can be injured by cycling as rises in prostate specific antigen (PSA)—a substance that can be released into the blood with prostate injury—have been seen following long rides. This rise in PSA could occur either with constant pressure or intermittent high pressure (pounding or trauma). 

Even though the study is far from definitive (its authors readily admit that), it’s certainly advisable for men to minimize prostate pressure and trauma. Fortunately, there are plenty of effective ways for cyclists to do this.

The most important point, however, is to keep riding. I am an old guy (69 years old) with a history of knee problems related to a football injury. After a few years running, which included finishing the Houston and Boston marathons, I developed chronic knee instability and arthritis, so I turned to cycling. As a cycling enthusiast, I now generally ride 60–120 miles per week; I’ve also been an oncologist for more than 30 years, so I have no reservations whatsoever in making that recommendation to stay in the saddle.

Cycling—like other regular exercise—has many health benefits and has been shown to reduce risk from diabetes, hypertension, and heart disease. As for cancer risk in general, the closer one is to an ideal weight, the less the risk. Bike riding or other forms of endurance exercise should be part of a personal wellness program that includes core and flexibility exercises, sensible eating, and not smoking. The health benefits, especially for older guys, far outweigh the risks.

And, yes, don’t forget to wear a bike helmet. 


 Dr. Hoverman’s Tips for Protecting the Nether Regions

Always wear well-designed padded shorts. 

Consider wider bike saddles and saddles with grooves or depressions in the center, so that the pressure is assumed by the sit bones and not the perineum. 

Keep the nose (or tip) of the saddle slanted slightly downward.

Make sure your bike fits well so that you do not have to extend the legs fully to pedal.

If you use aero bars to cycle, it is important to keep the sit bones over the wide part of the saddle and not creep toward the nose.

Avoid extra weight, whether body weight or carried weight, which can increase pressure on the perineum. Bicycle commuters should consider using a bike basket rather than a backpack.

Standing up off the saddle, using shock absorbers, and avoiding rough surfaces can reduce perineum and prostate trauma (think about the pounding Tour de France riders endure going over those cobblestones).

Consider riding on wider tires with less tire pressures.

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