Can cycling damage the prostate? What men can do to protect themselves

According to Cycling UK, 8 million people regularly cycle more than three days a week, and every weekend, thousands of Middle-Aged Men in Lycra (MAMILs) delight us with their alluring body-hugging regalia.

Cycling is a splendid form of exercise, but some studies are suggesting there may be a sinister side to its benefits. The prostate, which lies in the lower pelvis, is subject to pressure and repeated minor trauma during a long cycle ride, which can cause inflammation.

Some researchers claim that over time, chronic inflammation can trigger prostate problems, including cancer and erectile dysfunction. Although the conclusions of these studies are debatable, strong interest in this issue is justified as prostate cancer is now the most common cancer in men (more than 42,000 new cases each year), and even if the link is partially true, it will affect a lot of men.

First of all, it must be emphasized that regular exercise is very healthy, and by motivating more people to become physically active, cycling should be applauded. It is firmly established that men and women who exercise vigorously for more than 2-3 hours a week have a lower risk of obesity, hypertension, raised cholesterol, type two diabetes, hence gaining protection from the biggest killers, including cancer, heart disease, dementia, and stroke.

An evidence review published in the British Journal of Sports Medicine confirmed that cycling outdoors helps maintain vitamin D levels and circadian rhythm, which boosts mood, enhances sleep patterns, lowers daytime fatigue, and improves motivation at home and work. Exercise improves skin tone, cognitive activity, and slows our aging ticking clock embedded deep in our DNA.

Many cyclists, therefore, justifiably argue that they are not only fitter and healthier but also more attractive, intelligent, and biologically younger than their sedentary counterparts.

With all these multiple benefits of exercise, it is not surprising that there are some concerns with the reliability of the data suggesting cycling is harmful to the prostate. First, these studies rely on self-reported observations rather than independent prospective robust data, so they are open to significant bias. Even if the correlation is true, a linkage also does not prove causation as other factors can affect the data.

For example, health-conscious cyclists are more likely to ask for a PSA blood test. If raised, this could trigger further investigations which lead to a diagnosis of cancer. Most of these cancers are low grade and may never have presented or been discovered many years later - picking up these low-risk cancers biases the incidence in cyclists. Also, it is true that the PSA can go up after a vigorous bike ride, so again cyclists are more likely to be investigated compared to non-cyclists.

Prostate cancer

The most highlighted study involved a survey of more than 5000 cyclists, recording their cycling frequency and history of cancer. They found a six-fold increase in prostate cancer in men among extreme cyclists (more than eight hours training a week) compared to those who trained less than four hours.

This triggered headlines such as "Cycling causes prostate cancer," but what the newspapers chose to omit, or failed to understand, was that there was only a 1.7% incidence of prostate in both groups - at least three times lower than the incidence in the general population of men of similar ages.

This increase in prostate cancer in extreme cyclists is still a concern and does have a rational explanation. In addition to inflammation, intense or unaccustomed exercise generates large quantities of free radicals which are a by-product of energy production. Free radicals can damage DNA, causing mutations, the first stage in cancer initiation and progression.

Graduated training programmes increase antioxidant enzyme production which mop up these free radicals. It's also important to eat a lot of phytochemical-rich foods such as green tea, turmeric, pomegranate, broccoli, cranberries, ginger nuts, herbs, and spices which enhance antioxidant enzyme formation and protect the DNA from free radicals.

Phytochemicals also have anti-inflammatory, gut health enhancing and direct anti-cancer properties. They improve mood, help muscle recovery, and protect joints, making exercise more comfortable and productive.

Low testosterone and erectile dysfunction

Looking irresistibly sexy in Lycra would be wasted if low testosterone and libido are causing erectile dysfunction (ED). Although it is known that regular exercise slows the natural age-related decline in erectile function and testosterone, very strenuous exercise can actually have the opposite effect and reduce testosterone levels in the longer term.

Low testosterone can contribute to fatigue, poor motivation, osteoporosis and low libido and ED. In addition, direct prolonged pressure on the perineum can potentially damage the adjacent nerves and blood vessels supplying the penis.

One large study did find a three times higher ED in cyclists but only in those who used saddles which caused penile numbness. This highlights the importance of buying a comfortable saddle which is specifically design to reduce the pressure on the prostate and surrounding nerves.

That said, many authors disagree with this link and suggest that the reduction in sexual frequency is caused by cyclists being more motivated by thoughts of their next ride on the road rather than their next ride in the bedroom!

A number of lifestyle and dietary measures can help prevent low testosterone levels after strenuous exercise. These include maintaining adequate Vitamin D levels by sensible sun exposure and taking a good quality supplement in the darker months. Avoiding deficiencies in essential minerals such as zinc, magnesium selenium, iodine, and chromium by eating mineral rich foods such as clams, mussels, edible seaweed, pumpkin and sunflower seeds.

These are also good arguments for including a well-designed multimineral complex in your daily health routine especially when training vigorously. Omega fats are needed to make testosterone so it's sensible to increase healthy fat intake, preferably from plant sources such as coconut, avocado, and olive oil as well as smaller oily fish such as mackerel, sardines, and anchovies.

Healthy "good" bacteria help reduce inflammation in the gut improving absorption of minerals and vitamins and enhancing sports performance. Their positive effect on immunity was highlighted in studies of athletes given lactobacillus probiotics who then had fewer breaks in their training programmes from colds and flu.

People with a health gut microbiome have lower inflammation in their whole body including their prostate. Strategies to improve gut health, include quitting smoking, lowering alcohol and processed sugar intake; eating healthy probacteria rich foods such as kimchi, kefir and sauerkraut as well as prebiotic high fibre foods such as in beans, mushrooms, herbs and vegetables.

Probiotic supplements also have a role and studies have shown that blends combining lactobacillus a prebiotic and vitamin D are particularly relevant for prostate cancer which is why Yourgutplus+ in combination and the phytochemical supplement Yourphyto have been selected for the latest national anti-prostate cancer nutritional intervention study.

In conclusion, first of all, don’t stop cycling, the data actually shows that moderate cycling reduces prostate cancer risk. However, the generation of free radicals and increased prostate inflammation remain potential concerns with intense cycling. Investing in a prostate-protecting saddle and adopting dietary changes will reduce this risk and enhance performance and overall wellbeing. In particular, boosting phytochemical-rich foods, enhancing gut health, avoiding vitamin D and mineral deficiencies.