Men may be notoriously reticent to talk about their health – and even more so when it concerns the more personal areas of the body. But when it comes to cycling, people often infer an association between time in the saddle and prostate or urological issues. Consultant urological surgeon at London’s Kings College Hospital and The Prostate Centre – and a keen cyclist himself - Christian Brown, tells us the truth about the link between cycling and men’s health.
road.cc: First of all, the big question: does cycling affect the risk of prostate cancer?
Christian Brown: Some years ago there was an article published that said the risk of prostate cancer in men who cycled regularly was higher than in those men who didn’t cycle regularly. However, this was bounced around a bit among my profession and it was essentially debunked. Cycling doesn’t cause prostate cancer.
However, the cohort of men that this article looked at - who cycled three times a week or who cycled more than 50km every week - did have a higher incidence of prostate cancer than men who didn’t cycle. We see these kinds of associations from time to time in medicine but there is no scientific link between cycling and prostate cancer.
In this study, the men who exercised regularly were more likely to go to a doctor to ask the question: ‘Am I alright?’ and then a small proportion had early curable cancer diagnosed. So we have to be careful about cause and association.
It’s interesting to note that in the same cohort, researchers also looked at infertility and erectile dysfunction and there was definitely no association between those issues and cycling.
So does cycling have any effect on prostate health?
In this case, I think you have to say yes. If you’ve got a tendency for any chronic issue with the prostate - particularly chronic pelvic pain syndromes and things like that - then the cycling position over the span of a long ride is not helpful. However, you can go some way to reduce it with effective padded saddles and shorts.
I think it’s also worthwhile explicitly saying that cycling has many more benefits than detrimental aspects to it, and cycling doesn’t actually cause these issues, but it can exacerbate them.
For instance, if you’re 55 or 60 years old and you have an enlarged prostate, riding your bike every weekend is not going to make that any bigger or smaller or cause you any more problems. But if you’re a young guy who gets a bit of prostatitis - or chronic pelvic pain syndrome as we call it now - then cycling can make it worse.
In my experience, some of these young guys who are keen on triathlons and do a lot of ultras and very long rides often say they really feel prostate pain the day after a big training session. But they live with it and it goes away, so it’s not debilitating.
Because of that slightly different nature of sitting on a saddle compared to a chair, can cycling highlight any early warnings of a prostate problem?
Not really, but the message to any man would be: whether you develop a new symptom cycling, or a new symptom sitting down or walking or wherever, you need to get it checked out.
Where cycling might help is that sometimes, when we’re doing things alone, we often think about things that we wouldn’t have chance to think about during normal busy daily life. So that’s when you might notice that something feels a little bit different.
As a general men’s health message, it’s noticing change that’s important. If something feels different compared with how it used to, then it’s worthwhile talking to your GP or a urologist about it, just in case it ends up being significant.
What specific symptoms should men be looking out for?
Generally, a change in the way you feel. The prostate is described as being felt deep inside the pelvis, around the anus, base of the penis, and in the perineum. That clearly is an area that really takes a battering with long cycle rides but if you develop a change of feeling there, you ought to get it checked out.
The other issue is change in the way that you pass urine. If you’re urinating more frequently day or night, or it’s becoming more difficult to pass urine, then that needs getting checked out, including passing blood of course.
How important are things like shorts and saddles?
They’re absolutely critical. I think that for anyone who is going to cycle regularly, having a good saddle and pair of shorts is as important as having a good pair of trainers if you’re a runner. You wouldn’t go running in a pair of Dunlop Greenflash because you know you’re going to get back pain, knee pain and everything else.
Of all the cycling kit that people have, a decent pair of padded shorts and a gentleman-friendly saddle – of which any bike shop will stock various brands and types – is really, really critical.
As a keen cyclist yourself, do you approach the way you cycle differently because of your knowledge of these issues?
That’s a bit difficult to say because I’ve cycled for such a long time. I remember buying a pair of padded shorts at university when I was 18 and commuting in London as a medical student, and thinking they were fantastic. I couldn’t believe I hadn’t bought any before. So I’ve worn padded shorts all my cycling life.
But one thing I do think is important is that I’ve replaced my shorts regularly. That’s a critical thing – your kit does need changing and updating. When you’ve had a pair of shorts for two or three years and you’ve worn them regularly, they lose their ability to protect you. With multiple washes, getting wet, and the repetitive absorbing of impacts - again it’s just like a pair of trainers - you’ve got to move on and change them from time to time. I don’t have any allegiance to any brands, but I do think you get what you pay for.
We always think of prostate cancer as being the big issue when it comes to prostate problems, but what other conditions are there?
Benign prostate enlargement is as common as grey hair and balding and is associated with age. Almost all men get benign enlargement issues that can cause voiding problems, such as straining, going to the toilet more frequently, poor flow and sometimes dribbling. Getting up at night is a key symptom.
Then there are prostate infections and prostate inflammatory conditions such as prostatitis and chronic pelvic pain syndrome. Some people can just have a painful prostate – perhaps after surgery, after an infection, sometimes it can arise just out of the blue. That’s where I think long bike rides can really exacerbate it, and I think that’s due to position and perineal vibration.
You’ve mentioned position a couple of times – how important is it?
Position is key and one of the things that’s relatively new to me – I’ve never been very techy with my own cycling, I’ve just enjoyed it – but friends of mine have been talking about bike fitting for years.
If you’ve got a tendency for any kind of orthopaedic problem or, in this case, a prostate problem, then having a bike fitting so that you are ergonomically right on the bike is very helpful. If you struggle with pelvic or perineal pain after riding, it might be worth having a fitting or addressing your cycling position just to see if it can optimised in any way.
For cyclists who have had prostate surgery, how quickly and how easily can they get back on a bike?
There are different types of prostate surgery but the general principle is, if you’ve had any type of pelvic operation or any type of prostate operation, it can be difficult and painful to get back in the saddle. The advice we always give is to leave it a good four to six weeks, let everything settle down and then go for a short trial ride near your home so you can get back easily.
There are no two ways about it, after prostate surgery you do need some time off the perineal pressure and agitation that you get with the vibrations in the saddle.
And when it comes to long-term health, you obviously feel the health benefits of cycling counteract any risks?
Absolutely. By keeping healthy, avoiding obesity, raising your metabolic rate – all things that cycling does – there are countless positive effects for mind, body and soul and it far outweighs any other consideration.
In the case of prostate cancer, there is a very clear and critical link between obesity and developing prostate cancer, and the metabolism of cancer cells in the obese is very different to those who aren’t obese. So not only do obese men have a higher incidence of prostate cancer, but if they get it, they tend to get a more aggressive version. That’s very clear in the literature and well understood.
Obesity is a risk factor in pretty much every disease – there are no wins with obesity, there is nothing it protects you from, it only causes problems. Cycling is a very good way to avoid obesity and, of course, it also reduces your blood pressure and it reduces your risk of diabetes, which are risk factors for cardiovascular disease and other illnesses.
road.cc We often hear that prostate cancer is something you die with, rather than die of. Is that incorrect?
Not necessarily. If you’re 45 and you’ve been diagnosed with an aggressive prostate cancer, you’re definitely not going to survive that unless we do something about it. However, if you’re 85 and a small amount of prostate cancer is found, you are probably going to live with it and will not die because of it. Clearly I am talking extremes here to highlight a point.
In every case, the earlier you know about it the better because it gives you options. One of those options could be monitoring or, if it’s aggressive, then it’ll be surgery, radiation or chemotherapy. It all depends on where you are in the spectrum of the disease, how advanced it is and where it is in your body.
We are seeing prostate cancer in lots of people under the age of 50 and, of course, life expectancy for healthy men is 80 to 90 on average these days and is going up all the time. So we do intervene a lot earlier so these men can lead a full and healthy life free of cancer.
What factors play a role in developing prostate cancer?
Genetics play a huge part. Although prostate cancer is very common, it does cluster in families. If you have prostate cancer in a first-degree relative – a brother or father – then it does increase your risk by about 20%, and particularly if they have had prostate cancer diagnosed before the age of 60.
If your father was diagnosed with prostate cancer at 55 and you’re 40 and you’re wondering if you should be tested, I’d say yes, have a test. If your father had prostate cancer at 85 it’s probably not so important to be tested.
One thing that a lot of people don’t know is that some of the same genes that cause prostate cancer are shared with breast cancer. If you have a mother or sister with breast cancer, it does increase your risk of prostate cancer. So you can actually inherit a gene from your mother that increases your risk of a male cancer.