Prostate and Biking

author : AMSSM

comments : 2

Has anyone else had a PSA (blood test for prostate cancer) test come back elevated and have it be blamed on too much time bouncing around on a bike seat?

Member Question

Has anyone else had a PSA (blood test for prostate cancer) test come back elevated and have it be blamed on too much time bouncing around on a bike seat? I recently went for an annual checkup and this particular test came back 5.8 (2.0-4.0 is normal). The doctor said, "Wow!" He told me to come back a week later with no biking in between. Second test comes back 4.8. Still too high but coming down. He doesn't want to go through the biopsy until he thinks it’s absolutely necessary, so now he says no biking for 2-3 weeks and he wants to do another PSA before deciding.   I went for the third PSA test following three weeks of abstinence and no biking. My doctor was a lot less concerned about the whole thing than I was for sure. The 3rd test comes back as 2.1 which was well at the low end of the 2.0 to 4.0 range.  Is there a relationship here of prostate health and biking?

Answer from Kyle Goerl, MD
Member AMSSM

To begin with, there does appear to be a relationship between biking and elevation of the Prostate Specific Antigen, or PSA. This situation also illustrates the limitations to the PSA test. The prostate is a part of the normal male reproductive tract. PSA comes from the prostate, and is a normal part of ejaculate in males, but it can also be found in the blood. The PSA test looks for levels of PSA in blood. Prostate cancer screening often involves the combination of a PSA test and a digital rectal exam (DRE), and some physicians recommend starting prostate cancer screening at age 55.

The problem with prostate cancer screening lies in the limitations of the PSA test. Naturally, an elevated PSA can be concerning, as the PSA can be elevated in prostate cancer. If elevations in the PSA are found early enough in prostate cancer, it may help initiate interventions that can treat the cancer. Unfortunately, the PSA can be elevated for other reasons as well. These include prostate infections (AKA prostatitis), BPH (Benign Prostatic Hyperplasia, a growth of the prostate with age that can lead to urinary symptoms), urologic surgical procedures, a DRE, and even ejaculation. Regular exercise does not appear to raise PSA levels, but a recent, well-done study in 129 cyclists aged 50-71 years did demonstrate elevations in PSA levels shortly after 55 km of biking. Other studies in the past looking at cycling and PSA levels demonstrated mixed results. This was the first study to look at a large number of study participants, in an appropriate age range, and test them shortly after an appropriately long ride.

In theory, cycling can cause elevations in the PSA because of where the prostate is located in the body. Just as a physician can easily reach the prostate with a finger just inside the rectum during a DRE, the saddle of a bike can also put some pressure on the prostate leading to an elevated PSA.

Unfortunately, once an elevated PSA is found, no matter what the reason, further investigation is warranted. In this case, you had repeat PSAs done, which thankfully showed the PSA levels trending down. This is very reassuring, as it is unlikely for elevations in the PSA due to cancer to trend down with the recommendations of his physician. If the PSA levels had remained elevated, then this would have likely led to further testing and procedures. These procedures are often accompanied with complications, including incontinence, impotence, bowel control issues, and even death. Your physician was conservative because he or she likely wanted to avoid these complications, especially when screening has shown little benefit, even in terms of saving lives.  

Just as no women wants to find a breast lump and undergo a mammogram, no man wants to have an elevated PSA. The difference is mammograms save lives, but the evidence is not nearly as compelling that a PSA test will do the same. For now, I think it is important to realize that the PSA is an inexact test, and levels that return to the normal range are reassuring. I encourage all readers of the appropriate age, namely 55 and above, to have a discussion with their health care provider about PSA screening before deciding to start, as positive tests can ultimately lead to heartache, unfortunate complications, and in this case, too much unnecessary time off the bike.

Kyle Goerl, MD

Primary Care Sports Medicine Fellow
Madsen Health Center
555 S. Foothill Blvd., Suite 301
Salt Lake City, UT 84112

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date: April 11, 2014