Pretty weird title for an article, eh? Doesn’t sound like two things which would have anything to do with each other, does it? Oh, but they have a lot to do with each other, at least as far as my own health is concerned, and it will take me a little bit to explain. I also have to apologize to all the ladies out there: this is strictly about a MALE issue with bicycles, so if you read on please understand that this information will only apply to your dad, your brother, your husband, your boyfriend or another significant male other.
In November of 2013 I went in for my regular physical. A week later, Doc calls me and says “Everything looks okay, with the exception of your PSA level. It’s a little high.”
The Prostate-Specific Antigen (PSA) Test measures the blood level of the protein PSA, which is produced by a man’s prostate gland. There are three primary reasons for an elevated PSA level: (1) an enlarged prostate, (2) inflammation of the prostate (called “prostatitis”), or … (3) … cancer. Doc explained that I do have an enlarged prostate (most men my age do), and so what we would want to do is wait a month and take a second blood test. We did that … and my PSA level had gotten even higher.
Doc refers me to a urologist, who we’ll call Doctor U. I go in for my appointment, Doctor U examines me, sits down, looks at the information I’ve filled out, and then he looks up at me and says “I didn’t detect anything during the exam. But your high PSA level and your family history suggest we should do a biopsy.”
With just an elevated PSA level, urologists will sometimes adopt what is called a “Watch and Wait” posture. This means the doctor will just have you come back periodically, test your PSA level again and give you a digital rectal exam (DRE) to see if things have changed. The Watch and Wait option works because the typical prostate cancer isn’t very aggressive; the saying goes that “You don’t die OF prostate cancer, you die WITH it.” Something else will usually kill you before prostate cancer does.
A couple of things make Watch and Wait an inappropriate option for me. For one thing, at 63-years-old I’m pretty young to just sit back and watch to see if I have cancer, and if a tumor will show up which will require treatment. As with all cancers, the earlier you catch it, the better the prognosis with treatment.
The second thing is that “family history” Doctor U mentioned. You see, my father died while still in the hospital following prostate cancer surgery. Note: he didn’t die because of the cancer, but of complications which arose as a result of simply being a 70-year-old man with cardiovascular disease having surgery.
Doctor U scheduled me for a Transrectal Ultrasound and Biopsy of the Prostate right after the holidays. I won’t go into the icky details of the procedure, suffice it to say although it wasn’t really painful, it was a bizarrely uncomfortable experience. Afterwards, Doctor U had his staff set another appointment for me in two weeks so I could return and get the results.
Wonderful. Two weeks of moping around wondering if I needed to update my will. Two weeks of passing a funeral home, everyday, on the way home from work, and wondering if I should just “stop in to look around.” Two weeks of having a macabre interest in television advertisements for local cancer treatment centers (“Don’t touch that dial … er … remote, Honey!”). Two weeks of online research about the pros and cons of chemotherapy and radiation treatment.
Indeed, in addition to some documentation about impotency associated with bicycle riding, I also discovered several other areas where the prostate and bike riding have an association. A report from PLOS (Public Library of Science), which involved an investigation of whether cycling altered PSA levels, indicates that PSA levels temporarily increased an average of 9.5% in healthy males 50-years-old and older. The recommendation was that men refrain from bike riding between 24 to 48 hours before a PSA blood test.
I also found a number of references which indicated that prostatitis can be aggravated by bicycling. Bouncing around on a bike seat for long periods can irritate a lot of things down there, and recommendations for addressing the problem run the gamut from adjusting the saddle to changing the saddle to changing the type of bike you ride.
The most common saddle adjustment for men is slightly lowering the nose of the saddle. A high saddle nose will dig into your perineum (that area between your anus and scrotum; in the urban dictionary: the “taint”). Usually, the biggest taint complaint is about a numbness down there, but since the prostate is directly above the perineum, bouncing around on your taint will definitely further irritate an inflamed prostate.
Another adjustment which can be tried is sliding the saddle slightly forward or aft on the rails to change the angle of your body and what part of your butt contacts the seat. Everybody’s sit bones are slightly different, and such an adjustment can mean the difference between relative comfort and absolute agony.
If saddle adjustments don’t work, then it’s time to look at a new saddle. Some saddles, like the Brooks B17 Imperial, have a cutout in the top in the area where your taint meets the seat, so that less pressure is put there. (Disclaimer: I’m an unapologetic fan of Brooks saddles; the leather in the saddle custom forms itself to your derriere over time, so pressure points are spread over a larger area of your butt.) Some saddles, like the Serfas RX line, have a groove down the middle of the entire saddle, so no matter how or where you sit on it, you will mitigate the pressure on your perineum.
If a cutout or grooved saddle doesn’t work, you can try going to a radically different type of seat called a “nose-less saddle.” The most well known seat of this type is probably the Hobson Easyseat. Not only does this saddle not have a nose, it consists of two separate, adjustable pads, one under each buttock. Reviews of the Easyseat — and other nose-less saddles in general — are all over the map; some people swear by them, but for other folks they do not seem to work very well. As with a lot of things bicycling, you probably have to experiment for yourself.
You can avoid the time and possible frustration involved in bike saddle experimentation by simply going to the gold standard of comfortable bicycling seating: a recumbent bicycle. Recumbent bikes are mentioned in a lot of articles as a solution to urogenital related bicycling issues. As a ‘bent rider myself, I can tell you that it isn’t even a contest between regular bikes and recumbents when the subjects are comfort and efficiency; the recumbent wins hands down. However, the subject of recumbent bikes is so broad that we really can’t give it its proper due here in the space of this article.
Talking more about recumbent bikes is also sort of off the subject, too. What we’re really talking about is how I had a biopsy one Friday, and two Fridays later I headed over to Doctor U’s office with a ludicrously maudlin air of Going to the Gallows. Doctor U comes into the examining room and says: “Good news: there is no sign of cancer.”
After getting that governor’s reprieve, I told Doctor U about my research into PSA levels and bicycles. “I have two other patients who are avid cyclists,” he said, nodding, “And both of them have elevated PSA levels.” I didn’t ask if knowing that fact would have altered his decision to recommend the biopsy, because I felt I already knew the answer: my elevated PSA level, along with my family history, probably upped the possibility of my having cancer to about 30%. Without the biopsy, I would be wandering around wondering if I had it or not, and a mere two weeks of that was quite enough, thank you.
Another thing I had quite enough of over that two weeks were the suggestions, by my well-meaning non-cycling friends, that I should find another form of exercise rather than bicycling. Their logic was that since a bicycle seat could aggravate other problems “down there,” and was so DANGEROUS anyway, why not just ditch the bike and engage in a safer, less traumatic way to keep in shape. Why not yoga?
Now, I have nothing at all against yoga, and there are some ways that yoga could benefit me in the same ways that bicycling does. I simply do not find yoga exercises — or any other kind of gym-like exercising — to be that much FUN. Knowing myself the way that I do, if a form of exercise isn’t FUN, I will just stop doing it. I find bicycling FUN, and I know all of my male cycling friends find it FUN also.
To any of my fellow FUN loving male bike commuters who find themselves in the same situation of considering a prostate biopsy, I have this to say: You’ve already overcome the silliness of bicycling as being “oh, so DANGEROUS,” so you’ll find this brief, weird unpleasantness relatively easy to deal with.
BluesCat is a resident of Phoenix, Arizona, who originally returned to bicycling in 2002 in order to help his son get the Boy Scout Cycling merit badge. His bikes sat idle until the summer of 2008 when gas prices spiked at over $4.00 per gallon. Since then, he has become active cycling, day-touring, commuting by bike, blogging (azbluescat.blogspot.com) and giving grief to the forum editors in the on-line cycling community.