Prostate Cancer Gay, Bisexual, and Other Men Who Have Sex wh Men: A Review - PMC

Contents:

• IN CHIGO, A NEW APPROACH TO GAY AND BISEXUAL MEN WH PROSTATE CANCER
• WHEN GAY MEN GET PROSTATE CANCER
• WHEN TO PROSTATE NCER, 'GAY MEN ARE ERASED,' PATIENTS SAY
• PROSTATE CANCER GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN: A REVIEW
• THE PROSTATE MATTERS A GAY MAN'S SEX LIFE
• UNRSTANDG PROSTATE CANCER GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN AND TRANSGENR WOMEN: A REVIEW OF THE LERATURE
• GAY AND BISEXUAL MEN'S CLIC
• WHAT GAY AND BISEXUAL MEN TREATED FOR PROSTATE CANCER ARE OFFERED AND ATTEMPT AS SEXUAL REHABILATN FOR PROSTATE CANCER: RULTS OM THE RTORE STUDY
• THE EXPERIENC OF GAY AND BISEXUAL MEN POST-PROSTATE CANCER TREATMENT: A META-SYNTHIS OF QUALATIVE STUDI
• CANCER FACTS FOR GAY AND BISEXUAL MEN

IN CHIGO, A NEW APPROACH TO GAY AND BISEXUAL MEN WH PROSTATE CANCER

Curt, 66, diagnosis and surgery were only the begng of a “clil and psychologil and emotnal adventure” — one he felt that many urologists were not equipped to handle, bee he was gay and the majory of doctors and their patients were symptoms are siar for all prostate ncer patients, cludg urary ntence, erectile dysfunctn, dimished libido and loss of ejaculate. But rearchers are fdg that those chang may echo through the liv of gay and bisexual men unexpected, and sometim more difficult, obstacl n be physil and emotnal, and may be reflected patients’ relatnships wh their partners.

Amarasekera, who has foced his reer on urologic re for gay and bisexual men and other sexual mori, is the program’s first is an emergg field of study driven part by the creasg number of prostate ncer patients who intify as gay or bisexual. Much of the fundg for rearchg diseas that may affect gay men has been funneled toward HIV; and some of the gay men who may have gotten prostate ncer – which is more mon wh age – died of AIDS and therefore are theoretilly missg om the data, says Simon Rosser, a profsor and director of the HIV/STI Interventn and Preventn Studi at the Universy of Mnota School of Public Health. Sce more gay and bisexual men are htg high-risk ag for prostate ncer the days, he says, "'s gog to bee a bigger issue for gay and bisexual men the next , and no doc on the pla n practice evince-based medice" sce there is no strong evince base.

Not that there's been an easy way to study the populatn; surveillance data ncer rearch isn't typilly nducted by sexual orientatn, adds Rosser, who's recg participants for the first treatment study on gay and bisexual men wh prostate ncer.

WHEN GAY MEN GET PROSTATE CANCER

It don't matter if you're gay or straight, " says Michael Hoyt, an associate psychology profsor at Hunter College New York whose rearch based on a small foc group of gay prostate ncer survivors will soon be published. " Other Battl Some Gay Men Wh Prostate Cancer FaceWhile gay men seem to have about the same rat of prostate ncer as men general – makg the most diagnosed ncer among all men, acrdg to the Centers for Disease Control and Preventn – a review nducted by Rosser and lleagu suggts that gay survivors have poorer sexual functng and lower qualy of life. But for many gay men, workg wh a provir who knows and honors their sexual orientatn is important part bee more often than straight men, "sex, at some pot has been a cril part of their personal story, " Hoyt one participant his study, for example, who felt that his provirs' failure to acknowledge his sexualy was a blow to who he was as a person – and a patient.

"Havg to fight battl and then havg a sexual self that you’ve fought for" should be acknowledged, he told the rearch a practil, medil standpot, too, unrstandg a patient's sexualy is important bee while all prostate ncer survivors have some sexual si effects om treatment, ankly, gay sex is different om straight sex – and treatment optns should be discsed acrdgly. For example, erectile dysfunctn is a mon si effect of both radiatn and surgery to treat prostrate ncer – and n affect gay men's sex liv differently sce "they need firmer erectns for peratn" than they'd need for vagal terurse, Wtmann says.

" But support om the gay muny is cril for men wh prostate ncer, pecially nsirg some of them have been rejected by their own fay members or geographic muni for their sexual orientatn, Hoyt and others have reported. The human papillomavis (HPV) vacce is also available for gay, bisexual, and other men who have sex wh men up to 26 years of age to prevent genal warts and other HPV-associated diseas and ndns such as oropharyngeal or anal ncer.

WHEN TO PROSTATE NCER, 'GAY MEN ARE ERASED,' PATIENTS SAY

But the unique challeng facg gay and bisexual men wh prostate ncer have largely gone who have sex wh men (MSM) are ls likely to get regular prostate ncer screengs, and those who are diagnosed are ls likely to have faial and social support, acrdg to rearch ced by the Natnal Instut of Health. Brass’ said his sexual functn was relatively good, but stead he stggled wh ntence for weeks — g as many as ne “pads” a day and stayg wh yards of a bathroom at all you’re gay and you go to a urologist who hasn’t alt wh gay men, they’ll tell you, 'Brg your wife wh you.

'"He joed a prostate ncer support group specifilly for gay and bisexual men at Mount Sai Hospal Manhattan, one of several anized by the natnal advocy anizatn wh other queer men “allowed to be very open about our feelgs — and our sexualy — and to be empathetic wh each other, ” Brass said.

“The medil muny say, ‘We don’t want to ask olr heterosexual men qutns that might upset them, ’" Simon Rosser, an LGBTQ health specialist and -thor of "Gay and Bisexual Men Livg Wh Prostate Cancer, " told NBC Rosser, PhD, MPH, is a profsor at the Universy of Mnota School of Public Health.

PROSTATE CANCER GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN: A REVIEW

Universy of MnotaA profsor at the Universy of Mnota School of Public Health, Rosser has received a $3 ln grant om the Natnal Cancer Instute to put together the first prehensive rehabilatn program specifilly for gay and bisexual men wh prostate ncer. Gettg the disease, ironilly, is somethg of a luxury for a gay men of Brass’ age: Too many had their liv cut short by the AIDS epimic long before they’d typilly be diagnosed (the average age for a prostate ncer diagnosis is 66) the advent of lifavg antiretroviral dgs the mid-1990s, though, gay men are fally reachg their goln years. Six future directns, to advance the study of the effects of prostate ncer GBM and to improve treatment, are words:: bisexual, ncer, gay, male, prostate, sexual rehabilatnIntroductnImprovg the health of lbian, gay, bisexual, and transgenr (LGBT) dividuals is a Healthy People 2020 goal.

3 Gay, bisexual, and other men who have sex wh men (GBM) who have been diagnosed wh prostate ncer may have differential health-related qualy of life and sexual health out than heterosexual men wh prostate ncer, but existg rmatn is almost always based on small studi, clil se studi, or an anecdote.

THE PROSTATE MATTERS A GAY MAN'S SEX LIFE

4, 5 Until recently, there have been sufficient data on this topic, pecially postncer diagnosis, part bee, “rearch on the relatnal ntext of ncer and sexualy has tend to be heteronormative, assumg that men are long-term, monogamo heterosexual relatnships, th excludg the experienc of sgle and gay men. The search terms/statements ed were “prostatic neoplasms” or “prostate ncer” or “ncer of the prostate” or “prostatic rcoma” AND “male homosexualy” or “gay men” or “bisexual men” or “men who have sex wh men” or “bisexualy. 17, 20, 28 Wh 14 of the publitns unrtaken for a special issue one journal, 36 the edors nclu, “If prostate ncer, general, is off most people's radar screen, then gay men wh prostate ncer are a tly visible speci.

49Santillo has intified six gay “liftyle factors” that potentially uld crease the risk of prostate ncer GBM: e of ttosterone supplements and anabolic steroids, e of fasteri (Propecia) for hair loss, HIV stat and antiretroviral (ARV) treatment, a fatty diet, the effects of anal sex on prostate-specific antigen (PSA) ttg, and poor doctor–patient munitn. In parg 341 heterosexual men wh 111 gay men, Allensworth-Davi reports gay men had worse urary and bowel functng sr, lower mascule self-teem, ls partner affectn, and more treatment regret than heterosexual However, he found no sexual differenc (possibly due to wordg differenc the sexual qutns8) major ncln of this quantative lerature review is that there are aquate studi to be nfint of fdgs, and where differenc are intified, they are based on small nvenience sampl of qutnable power and unknown generalizabily.

40 Anecdotal evince shows that GBM wh prostate ncer face unique challeng, cludg the loss of the prostate as a se for sexual pleasure receptive anal sex, 23, 77 loss of ejaculate (which thors emphasize is more central gay sex17, 32, 34), persistent rectal irratn or pa sufficient to prevent receptive anal sex, 5, 30 and erectns too weak for sertive anal sex34 (Anal peratn is timated to require 33% more rigidy than vagal peratn78). 4, 33 Distst of the medil muny5 and reluctance to disclose sexualy to provirs19, 77 are mon barriers, wh 21% of 2560 olr LGBT (aged 50–95) reportg they are not “out” to health provirs and 13% reportg homophobic re.

UNRSTANDG PROSTATE CANCER GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN AND TRANSGENR WOMEN: A REVIEW OF THE LERATURE

25 In ntrast, urologists were intified as particularly unhelpful: “The nservative hetero-normative and sometim homophobic nature of those volved the medil procs of prostate ncer rulted distrs, dissatisfactn and negative psychologil impact for participants. 107We found three se reports documentg effects of prostate ncer on GBM upl: one where the patient was treated wh radil prostatectomy, 31 one where both were diagnosed at about the same time and treated wh proton therapy, 19 and an exploratory study of sexual functng three gay upl, where one was treated for prostate ncer.

GAY AND BISEXUAL MEN'S CLIC

The impact of the AIDS epimic rcg the hort of olr gay men the Uned Stat by an timated 25% and the number of olr men who are not sexually active would lead this to be an overtimate; however, the broad range timat of GBM and gay male relatnships, together wh signifint unrreportg bias to socially sensive and potentially stigmatizg ems, potentially unteract this Allensworth-Davi D.

WHAT GAY AND BISEXUAL MEN TREATED FOR PROSTATE CANCER ARE OFFERED AND ATTEMPT AS SEXUAL REHABILATN FOR PROSTATE CANCER: RULTS OM THE RTORE STUDY

Gay men are more likely to enunter this ncer than heterosexual men, not bee they are at a higher risk but bee they and their partners uld both velop they share many of the same challeng as their heterosexual peers, there are signifint differenc, Dr Gary Morrison, a Sydney-based health nsultant, says. Morrison says the new rourc follow through and provi the implitns of each choice for gay and bisexual regnise that the social environment for gay men is different, that their sexual practic are more versatile and that prostate ncer might have a broar effect.

This ncer has the potential to change their whole life as gay men, " Morrison n change their self-image and their sense of masculy, to the extent that pursug a sexual life n be more plited and the imagery and language of rmatn about prostate ncer has tradnally been heterosexual, Morrison says the new rourc e the language of the gay muny and don't hold and rmativeThey are lm and rmative and although the gay muny is diverse, everyone om bankers to bikers n unrstand them.

THE EXPERIENC OF GAY AND BISEXUAL MEN POST-PROSTATE CANCER TREATMENT: A META-SYNTHIS OF QUALATIVE STUDI

Dpe good tentns, discrimatn and homophobia still exist the health system and when to prostate ncer assumptns are often olr unmarried man is assumed to be sexually active, jt as 's assumed that after treatment a wife will llect the man and take re of him at talk about gay sexualy such an environment n be dntg and the booklets suggt men seek health profsnals they feel fortable booklet quot a man sayg that others "jt don't get what means to be a gay man and the importance of the prostate a gay man's sex life". Radiatn has a range of issu too, such as a slow cle potency, rctn ejaculate and bowel pa worseFollowg radiatn, the receptive partner might fd anal sex mak the pa worse and damag the lite lg of the an and booklets ver the entire prostate ncer experience, om qutns of ttg to tryg to start a new relatnship when treatment is nature of relatnships and emotnal support stctur gay muni is often different to heterosexual muni and gay men often talk about a greater sense of isolatn.

The webar brought together prostate ncer experts, patient advot and health dispary experts to discs how the tersectn of racial and sexual mory stat impacts the experience of Ain Amerin Gay and Bisexual Men wh prostate ncer re. Published fal eded form as:PMCID: PMC8923623NIHMSID: NIHMS1779994AbstractIntroductn:This is the first known study to vtigate what gay and bisexual men are offered and what they try as rehabilatn to addrs the sexual and urary effects of prostate ncer treatment.

CANCER FACTS FOR GAY AND BISEXUAL MEN

5, 6 By extrapolatn between 97, 845 and 123, 006 gay, bisexual and other men who have sex wh men are livg wh a diagnosis of prostate ncer, cludg 39, 138 to 73, 804 men male and urary dysfunctn are the 2 most mon problems followg prostate ncer treatment. 13, 21–23 Those overseeg trag programs for urologists, onlogists and others providg prostate ncer re need to ensure trag basic sexual unselg (eg PLISSIT mol16, 24) and the culturally petent prostate ncer treatment of gay and bisexual terpretg the rults of this study, a key limatn to nsir is the challenge of retrospective rell.

On balance we believe is reasonable to e the methods to ga an ial picture of what survivors geographilly diverse, our study sample is fairly homogeneo, and we utn that the rults might not generalize beyond a gay intified, whe, North Amerin sample. Supplementary MaterialSupplementary AppendixTable 1Table 2Table 3Abbreviatns and AcronymsGBMgay and bisexual StatFootnotNo direct or direct mercial centive associated wh publishg this rrpondg thor certifi that, when applible, a statement(s) has been clud the mancript documentg stutnal review board, ethics mtee or ethil review board study approval; prcipl of Helski Declaratn were followed li of formal ethics mtee approval; stutnal animal re and e mtee approval; all human subjects provid wrten rmed nsent wh guarante of nfintialy; IRB approved protol number; animal approved project received universy human participants protectn program approval. The review suggts that more support groups specifilly for gay and bisexual men should be tablished, while urologists should ter to the sexual and mascule implitns of treatment, and not ame problems for gay and bisexual men heterosexual terms.