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Biopsies and Bicycle Saddles

by BluesCat

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.

I also researched “bicycle prostate problems” because I had heard that bicycling could cause impotency problems and wondered if there might be some other issues with a bicycle/prostate connection.

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.


BluesCatBluesCat 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.

 
Burley nomad 229

15 Responses to “Biopsies and Bicycle Saddles”

  1. Jeff says:

    Good post. Glad you’re okay.

  2. Phil Merritt says:

    As a 44 year old, I just went through an entire summer of what you just described. My grandfather died of p cancer so when after passing a kidney stone the Dr. found out my prostate had been firm a year and a half previously at a physical for work he decided it was time for a DRE. He found it hard with nodules and put me on antibiotics for awhile then checked again. Still hard, he continued the antibiotics and scheduled a biopsy. The biopsy was done the Monday before Thanksgiving and then more antibiotics.
    Just like you thankfully no cancer but the meds sure did sap my energy levels and now in February I am finally starting have my old vigor back.
    I brought up the biking aspect to my urologist and he didn’t seem to worried about it.

  3. Kevin Love says:

    Glad to read that you are OK!

    A couple of points.

    1) In The Netherlands, where almost everyone cycles, men are not dropping like flies with prostate cancer. In fact, Dutch health is much better than that in the USA. Which also could have something to do with mass cycling.

    2) In the study linked to, the PSA levels were measured 5 minutes after a very long bike ride. This is not how PSA tests are normally done.

  4. BluesCat says:

    Jeff – Thanks, a side affect of this whole experience — in the short term, at least — is that I’m watching my diet more closely; paying particular attention to prostate healthy and antioxidant rich foods. It may be too soon to tell, but I really feel like I have more energy. One thing I refuse to give up is my beer; some studies say the suds are harmful to the prostate, but more recent information says alcohol reduces the risk of complications with an enlarged prostate. Until Doctor U tells me differently, I’ll continue toasting my bicycling exploits with Blue Moon!

    Phil – As you no doubt know, one of the primary risks of a prostate biopsy is infection. Doctor U had me take antibiotics the day before, the day of and the day after the procedure. I didn’t notice any side affects of the medication, but then I didn’t have an infection to begin with. One thing I found out from my research was that adequate hydration will help avoid both prostate problems, kidney problems and urogenital problems in general. Most people run around dehydrated, but since I’m a long time desert backpacker and bike rider, drinking copious amounts of water is like second nature to me.

  5. BluesCat says:

    Phil – Oh yeah, one other thing: my understanding is that the elevated PSA level associated with bicycling DOESN’T mean you’re somehow hurting your healthy prostate via bike riding. For all they can tell, it is just an interesting consequence of taking to a bike saddle.

  6. I went through the whole bit … elevated PSA, prostate biopsy and, ultimately, a radical prostatectomy in 2013. My doc told me to stay off the bike for 3 months following the surgery, despite my showing him pictures of all kinds of exotic, “no pressure” seats. (In addition to the Hobson, I’ve tried the Spongy Wonder and The Seat. All good!)

    What saved me ultimately was the ElliptiGO (www.elliptigo.com). It’s a bike you stand up on, and ride like an elliptical machine at the gym. Great fun, great exercise, and absolutely no pressure on the nether regions. (I have no connection with ElliptiGO. I’m just a fan!)

  7. BluesCat says:

    Kevin – Thanks! A chart at the statistical site NationMaster shows that Americans can still shout “We’re Number One!” in at least one category: obesity. We’re the unarguable champs at 30.6% (almost a third of our population). The Netherlands, on the other hand, are a laughable number 20 on the list, with a puny 10% of their population in the noble Super Fat range. Obesity is one of the prime risk factors for a number of cancers, and I believe that aggressive prostate cancer is one of them.

    When I told Doctor U about the suggestion that healthy men over 50 should avoid strenuous biking for 24 to 48 hours before a PSA test, he thought for a moment and said “Since the ‘half-life’ of PSA is about four to five days, I would say the affects of cycling would probably last much longer than just two days.” So, I would argue that the results of the study would still be valid. Remember: PSA level is just one of the risk factors for prostate cancer, and some researchers are arguing that it is more of a warning signal, to be used in conjunction other tests and factors like genetics and the aforementioned obesity.

    Tech Curmudgeon – Glad to hear you are on the mend! When I first started riding my ‘bent, my eyes were opened to an expanded world of two-wheeled transportation which included regular recumbent bikes, recumbent trikes and a host of unusual self-powered vehicles like ElliptiGO. In the video on their web site, I saw one guy with a knapsack, so I guess it could be argued you can use them for commuting!

  8. Chris says:

    Hi,

    I don’t have any experience with the PSA aspects, but I do have a few general comments pertaining to this article.

    Probably about a year and a half ago. I had some kind of little lump on the outside of my anus. Of course I proceeded to go to my doctor for them to have a look at it. They had told me it was an external hemorrhoid, and she explained to me the various factors that would cause this medical issue I was having. I never had such a problem ever in my medical history.

    I told her that none of those factors were relevant in my life at that time. I asked her if a bicycle saddle that was too narrow could have caused this, and her answer was “yes, of course it could”. So I told her that I was confident that this is what caused the ext hem.

    The reason I asked her this, was the saddle I was using my the original factory saddle. One that I had been using for many, many years. Although I started biking recently much more in this segment of my life. I assumed that my body shape changed over time, and the saddle was simply too narrow.

    I followed her directions, and stayed off my bicycle I think for about two weeks. Along with some other healing treatments. It did not take long and the ext hem completely went away, and has not returned since. Of course we discussed my getting a new properly fitted saddle.

    My main message is that your body needs a certain width saddle. As you explained to meet the width of your sits bones. Too narrow and you cause pressure in the wrong places on your body. Too wide and you can limit hip rotation movement, which is not great either. Though the width of saddle has some play depending on your riding style. A forward leaning style creates a more narrow bone sits profile, a more upright riding style opens your sits bones a bit more wide.

    It’s good to use the measuring tool that some bicycle shops have. This gives an accurate measurement of your sits bones. If the store does not have the measuring tool, I would look for a store that does have one. The measuring tool manufacturer can offer width recommendations based on your riding style, once you know your natural sitting sits bones width.

    I find that the springs/pads/gel, etc is not good choices. With these product choices you create more contacts points with your body. You just want contact with the sits bones. These marketed shock absorbing saddle choices cause more friction on areas your body does not need it. Really the arch in your lower spine is a natural shock absorber, as well as your hips. As you ride engage knees, hips, arch in spine at bumps, etc.

    With a properly fitted saddle, and good body mechanics. These stories in the media that riding is not good for your tush – is just hog wash.

    When I read your story about PSA levels, etc. I really get the sense that family history plays a very big role in this. Though a properly fitted saddle is very important as well. My sense is that many riders don’t really identify this importance of saddle sizing.

    I’m receiving my first Brooks saddle very soon. They happen to have a model in the exact width that I was looking for. Looking forward to adding it to my fairly newly acquired Brompton! The original Brompton saddle is 10mm too narrow for me. So it was useless from the very beginning.

    Sorry for the long message. Thanks for sharing your very personal story.

  9. BluesCat says:

    Chris – I never have been able to find a road bike saddle which has been comfortable for me. Like you have discovered, they all seem to be too narrow for me.

    The “tool” for sit bone measurement that I’m familiar with is really nothing more than a small sheet of compressible foam that you sit down on, in a riding position, for a minute or so and then hop up and measure the distance between the centers of the two indentations. There’s also some sort of calculation you need to do at that point that I can’t remember.

    Tip about the Brooks saddle: you really do want to use the Proofide product to maintain and break in your Brooks; it’s not a marketing scam. Do not use saddle soap or any other leather treatment.

  10. Ted Johnson says:

    Hey, BluesCat: Great article and great discussion. I don’t know if my PSA has ever been tested. I’ll have to ask my doctor.

  11. BluesCat says:

    Thanks, Ted. Expert opinion varies widely on when, and even if, men should be given a PSA test. My understanding is that a lot of general practitioners include the PSA test in with the regular yearly blood test for their male patients around the age of 50; and sooner, around age 40, if the patient has other risk factors: a family history of prostate cancer, a previous bout with another cancer, etc.

    But some doctors feel the PSA test is unreliable, and may cause unnecessary stress or lead to unnecessary biopsies and/or treatment for a slow moving cancer.

    Speaking for myself, I’m pretty happy to know that my elevated PSA is no mystery, but is caused by an enlarged prostate; not by a hidden killer. Although the odds are in your favor that an elevated PSA does not mean cancer, the flip side to remember is that prostate cancer is the second leading cause of male cancer deaths in American men.

  12. Joe Maki says:

    Myself, my roommate and a friend all went through this in our early to mid 50s, which is pretty early for a PC diagnosis. We are all cyclists. I would not be surprised if there is some relationship. Anything that continually abuses that part of your anatomy could be a factor :) I still wouldn’t quit cycling. I’ve been cancer free for 10 years.

  13. BluesCat says:

    Joe – Wow. Yeah, when I first started back riding in 2002, I rode my 1986 Batavus Course off and on along with my Giant Yukon mountain bike. The Batavus has a better, after-market seat than the horrible, skinny, hard plastic saddle it came with originally. But it is STILL a skinny road-bike thing and I tried all manner of trying to adjust it to get it so it wouldn’t hurt. I never tried a nose-less saddle or a cut out saddle simply because I didn’t ride the bike often enough to warrant the expense of a different saddle.

    I discovered Brooks saddles around 2008 (I think), and my Flyer has allowed me to be much more comfortable on the Giant. Then I got my recumbent and I’ve never worried about comfortable cycling again.

  14. Ted Johnson says:

    Noseless saddles seem like a good idea, except for one problem:

    When I’m going down a long hill and nobody is looking, I like to stand on my pedals, take my hands off the handlebars and stand straight up with my arms held out — like Kate Winslet on the prow of the Titanic.

    Hold that image in your mind for a second.

    Without a saddle nose between my thighs, I wouldn’t be able to balance the bike.

  15. BluesCat says:

    Ted – LOL! Okay, so, lemme see now: If I have a choice between doing a great Rose DeWitt Bukater imitation, and punishing my taint … since I ain’t got the looks of Kate anyway, I’ll pass on the former.

    Hey, even if nobody is looking when you start, don’t they run to their windows to watch when they hear you screaming “I’m QUEEN of the world!”?

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