Sex After Prostate Cancer Gay and Bisexual Men: A Review of the Lerature - ScienceDirect

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
• CANCER FACTS FOR GAY AND BISEXUAL MEN
• UNRSTANDG PROSTATE CANCER GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN AND TRANSGENR WOMEN: A REVIEW OF THE LERATURE
• GAY MEN'S EXPERIENC WH PROSTATE NCER: IMPLITNS FOR FUTURE REARCH
• REVIEWSEX AFTER PROSTATE CANCER GAY AND BISEXUAL MEN: A REVIEW OF THE LERATURE
• THE SEXUAL FUNCTNG OF GAY AND BISEXUAL MEN FOLLOWG PROSTATE CANCER TREATMENT: RULTS OM THE RTORE STUDY
• A GAY MAN’S GUI TO PROSTATE CANCER
• GAY MEN'S EXPERIENC OF SEXUAL CHANG AFTER PROSTATE NCER TREATMENT-A QUALATIVE STUDY SWEN
• PROSTATE CANCER SCREENG FOR GAY MEN THE UNED STAT
• CANCER RISKS 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.

”The gay and bisexual men their 50s and 60s who are now enterg the prime mographic for prostate ncer also lived through the worst of the AIDS epimic. V., and young gay men, bee that was the biggt killer, ” said Simon Rosser, a profsor of epimlogy and muny health at the Universy of Mnota, who led a study 2017 of gay and bisexual men wh prostate ncer. “It’s only now that as the AIDS generatn grew olr, and aged to health problems like prostate ncer, that specialists are startg to see gay patients.

WHEN GAY MEN GET PROSTATE CANCER

Amarasekera studied urologists’ trag and found that many reported receivg ls than five hours of stctn on the treatment of gay and bisexual patients. “It’s important to llect data on how treatment affects sexual functn differently for gay and bisexual men, who have different sexual repertoir than straight men, ” he said. Amarasekera se at the program’s two clics — one downtown Chigo and the other the historilly gay Northalsted neighborhood — are unprepared to face yet another health crisis.

“Partial erectile dysfunctn has a particular impact” on gay patients, she said, and they “report signifintly greater ncern about loss of ejaculate than heterosexual men. Amarasekera “nsired my whole person, and my whole personhood enpassed my beg gay, ” he ia also spired Perry McKay, a Chigo philanthropist whose donatn helped get the Northwtern program off the ground.

“This is an opportuny to munite, tra and te urologists on how to provi better re tailored to the specific needs of gay and bisexual men, ” he Rosser agreed. Though the ter landspe has changed sce his diagnosis 2003, Rose's experience is still reprentative of the lack of awarens and rearch surroundg how prostate ncer may affect gay men differently than straight men. 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.

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

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.

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.

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

For one, some gay men Hoyt's foc group reported strs around disclosg their sexual orientatn to their health provirs, while others worked wh clicians who didn't know and didn't ask. 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. For Rose, who joed a maly gay nng club a few years after his surgery, havg people his life who listened to and supported him throughout the journey has been key to his well-beg.

CANCER FACTS FOR GAY AND BISEXUAL MEN

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.

And if their health re provir is not culturally petent, gay and bisexual men are much ls likely to unrstand how treatment will impact their qualy of life.

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

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. "A NEGLECTED AREA"It’s impossible to know how many gay men have been diagnosed prostate ncer, bee qutns about sexualy are rarely clud rearch studi. “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.

GAY MEN'S EXPERIENC WH PROSTATE NCER: IMPLITNS FOR FUTURE REARCH

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.

And we have studi that show out are different for gay men: We have worse mental health, we have greater urary problems, but our sexual out are reliably better. 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.

Koy, MD, MBA, 4 Darryl Mteldorf, MSW, MPA, 5 and William Wt, PhD6AbstractPurpose: Prostate ncer gay, bisexual, and other men who have sex wh men (GBM) is an emergg medil and public health ncern. 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.

REVIEWSEX AFTER PROSTATE CANCER GAY AND BISEXUAL MEN: A REVIEW OF THE LERATURE

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. We exclud studi whose primary foc was on heterosexual men that provid eher no or limed asssment of homosexual men and studi that equably clud other orbidi their analys (cludg other malignanci).

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.

THE SEXUAL FUNCTNG OF GAY AND BISEXUAL MEN FOLLOWG PROSTATE CANCER TREATMENT: RULTS OM THE RTORE STUDY

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. 82 One explanatn is that “Many gay men have had bad experienc wh the healthre system and is difficult for them to be open wh their urologist about the fact that they are gay.

A GAY MAN’S GUI TO PROSTATE CANCER

17 Goldstone30 scrib munitn wh one's doctor, as cril, but not his experience as a surgeon that gay men may be embarrassed to ask about sexual functn. Olr gay men wh prostate ncer may have greater difficulty disclosg their sexualy to healthre provirs and/or volvg partners than younger GBM who me out, post-Stonewall. 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.

”25 As one participant noted, “… we need to have urologists clued up to al wh gay men, we need unrstandg that our needs and issu are not the same as (those of) a heterosexual man. Inty challeng In a qualative study of 14 heterosexual men and 4 homosexual men, prostate ncer and erectile dysfunctn were intified as major threats to mascule inty. 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 MEN'S EXPERIENC OF SEXUAL CHANG AFTER PROSTATE NCER TREATMENT-A QUALATIVE STUDY SWEN

11 The thors note that gay upl may engage novel acmodatn practic, such as change sex rol and open relatnships, which have not been noted heterosexual upl. AcknowledgmentsThis article was veloped as part of the Rtore study, a Natnal Cancer Instute-fund grant award tled, “Unrstandg the Effects of Prostate Cancer on Gay and Bisexual Men” (Grant No. 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.

Fear of discrimatn: Some gay and bisexual men don’t tell their health re provirs about their sexual orientatn, bee they worry about discrimatn affectg the qualy of health re they receive.

The purpose of this review is to summarize the state of the science on prostate ncer gay, bisexual, and other men who have sex wh men (GBM) and transgenr women (TGW).

PROSTATE CANCER SCREENG FOR GAY MEN THE UNED STAT

This qualative study explored gay men's experience wh prostate ncer wh a foc on the emotnal, physil, and sexual impact of ncer; support needs; and healthre teractns.

A nventnal ntent analytic approach was ed to intify six primary ntent areas that scribed poignant aspects of the men's experience wh prostate ncer: mory strs, timacy and sexualy ncerns, impact on life outlook, healthre experienc, social support and the gay muny, and tersectnal inti. ObjectivTo highlight the unique ncerns, experienc, and needs of gay and bisexual men wh PCa by reviewg the lerature on sexual out this patient populatn. MethodsA lerature review through June 2019 was nducted, wh a foc on sexual out gay and bisexual men wh PCa; parisons of sexual out between heterosexual and gay and bisexual men wh PCa; and the health re experienc of gay and bisexual men wh PCa, specifilly wh regards to discsg sex wh health re provirs.

CANCER RISKS FOR GAY AND BISEXUAL MEN

They face heteronormative bias and homophobia the health re system and are equently dissatisfied wh the rmatn they receive wh regards to PCa and sexualy. ConclnThere has been limed rearch on the experienc of gay and bisexual men wh PCa; addnal rearch to replite and extend upon the fdgs of prev studi is warranted. The paper also highlights issu of particular ncern to gay men cludg the potential effect of ttosterone supplements, HIV stat, anal sex and s impact on PSA ttg, and the potential change sexual rponse durg anal sex rultg om the removal of the prostate.

He offers observatns om his own practice as an openly gay urologist about the ways which prostate ncer affects gay men and his velopment of an Inter group for gay men wh prostate ncer. This problem n be particularly difficult for gay men to al wh as many are too aaid or embarrassed to discs altered sexual functn wh their physicians and sexual partners. Usg exampl om his psychotherapy practice, the thor picts and offers treatment strategi for the psychologil reactns to diagnosis, treatment, and the nsequenc of treatment as they affect the gay man stgglg wh prostate ncer.

As gay men navigate the heterosexually biased world of prostate ncer treatment, they mt also nont potential problems of stigmatizatn, cludg srrg, ejaculatn problems, erectile dysfunctn, and HIV/AIDS envy. The thor strs the need for gay oriented programs and genr bias ee materials as both appropriate and empowerg to the muny of all prostate ncer patients and their fai.