What's Guidg Prostate Cancer Care for Gay Men? | MedPage Today

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
• CANCER FACTS FOR GAY AND BISEXUAL MEN
• PROSTATE CANCER GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN: A REVIEW
• REVIEWSEX AFTER PROSTATE CANCER GAY AND BISEXUAL MEN: A REVIEW OF THE LERATURE
• GAY MEN'S EXPERIENC WH PROSTATE NCER: IMPLITNS FOR FUTURE REARCH
• A GAY MAN’S GUI TO PROSTATE CANCER
• CANCER RISKS 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
• THE EXPERIENC OF GAY AND BISEXUAL MEN POST-PROSTATE CANCER TREATMENT: A META-SYNTHIS OF QUALATIVE STUDI
• WHAT'S GUIDG PROSTATE CANCER CARE FOR GAY MEN?
• THE PROSTATE MATTERS A GAY MAN'S SEX LIFE

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.

WHEN GAY MEN GET PROSTATE CANCER

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.

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.

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

" 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. 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.

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.

CANCER FACTS FOR GAY AND BISEXUAL MEN

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. 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.

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

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).

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

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.

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. 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.

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

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.

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.

A GAY MAN’S GUI TO PROSTATE CANCER

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. 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.

Abstact: A sexually active Lato gay man scrib how the surgil removal of his prostate gland affected his thoughts, feelgs, attus and activi about sexualy general and specifilly about how the physil chang he experienced engenred emotnal chang his own stggl wh sex and masturbatn. Abstact: Dcribg himself as a physilly f and sexually-active Ain-Amerin gay man of mature years, and havg survived more than a of beg HIV-posive, the thor wr about beg faced wh another signifint and pletely new challenge to his health and qualy of life: prostate ncer. They highlight 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.

In “Psychotherapy wh Gay Prostate Cancer Patients, Darryl Mteldorf, CSW, exampl om his own practice to highlight psychologil issu that surface dividual psychotherapy wh gay men diagnosed and treated for prostate ncer. 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. Keywords: gay, special populatns, bisexual, special populatns, prostate ncer, onlogy/ncer, male sex role, genr issu and sexual orientatn, masculy, genr issu and sexual orientatnProstate ncer is the send most mon ncer men and the sixth leadg e of ath ternatnally [World Cancer Rearch Fund Internatnal (WCRFI), 2015].

CANCER RISKS FOR GAY AND BISEXUAL MEN

Although prostate ncer is more prevalent black men (1 4) aged 45 or above (Thompson, 2014), and for other ethnici aged 50 or above, there is no evince that gay or bisexual men are more specifilly at risk of velopg prostate ncer (Prostate Cancer UK, 2016). A study nducted by Motofei, Rowland, Popa, Kreienkamp, and Pni (2011) asserted that gay men diagnosed wh prostate ncer were experiencg worse sexual functng and were more ncerned about their abily to mata an erectn post-prostate ncer treatment than their heterosexual unterparts.

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

While gay and bisexual men may experience siar challeng to that of heterosexual men followg treatment, their sexual ntext is different and their treatment out were found to be worse (Simon Rosser et al., 2016a), wh lower mental health functng and a greater fear of ncer recurrence, thereby affectg their qualy of life (Hart et al., 2014). Wassersug, Lyons, Dunn, Dowsett, and Pts (2013) discerned that there were no signifint differenc between gay men and heterosexual men receivg different treatment modali or experiencg ED; however, gay men reported that they were bothered by their abily to ejaculate and this si-effect was emed more of a problem to this group of men than their heterosexual unterparts.

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

The thors state that a number of psychologil terventns have been veloped for heterosexual men to addrs their ncerns; however, there is an absence of specific terventns to addrs the needs of gay men thereby creatg this equy treatment.

Although gay masculy is margalized and nigrated by tradnal hegemonic masculy (Kahn, 2009), there is evince to suggt that societal ncepts of masculy do affect the self-image of gay men (Sanchez et al., 2009) to the pcy of lerature this area, this review will foc on the experienc of gay and bisexual men followg prostate ncer treatment. Study participants were male, gay or bisexual, sgle or a relatnship, had been diagnosed wh prostate ncer and had been treated for prostate per qualative meta-synthis methods, the excln creria were quantative papers, mixed methods papers, edorials, abstracts, opn piec, nference extracts, review papers, dissertatns, sendary analys, meta-synth, lerature reviews, non-English language papers, surveys, qutnnair, studi that were pre-therapy, or rporated other typ of ncer, and studi that clud heterosexual men and transgenr women.

18 intified as gay, 1 intified as bisexualDurg or after treatment, men reported receivg a range of stmental support, largely a functn of relatnship stat and treatment typeExplorg gay upl’ experience wh sexual dysfunctn after radil prostatectomy: A qualative studyHartman et al. 3 were patients, 3 were partnersEquable rehabilative support is cril to assist homosexual upl manage distrs associated wh prostatectomy-related sexual dysfunctnGay men’s experienc wh prostate ncer: Implitns for future rearchHoyt et al. (2017) Uned StatTo explore gay men’s experienc wh prostate ncer wh a foc on the emotnal, physil, and sexual impact of ncer, support needs, and health-re teractnsFoc groups6 Whe men & 5 Ain Amerin men, aged 43–84 yearsMory strs, timacy and sexualy ncerns, impact on life outlook, health-re experienc, social support, and tersectnal inti all impacted on men’s experiencImpact of prostate ncer treatment on the sexual qualy of life for men-who-have-sex-wh-menLee et al.

WHAT'S GUIDG PROSTATE CANCER CARE FOR GAY MEN?

18 intified as gay, 1 intified as bisexualAll sexual behavr wh other men, not jt sertive anal sex, was affectedThe experienc of gay and bisexual men diagnosed wh prostate ncer: Rults om an onle foc groupThomas et al. Each theme is explored tail g the data extracted om the qualative studi and supported by quotatns where ImpactGay and bisexual men this meta-synthis experienced difficulti engagg sexual activy after prostate ncer treatment.

THE PROSTATE MATTERS A GAY MAN'S SEX LIFE

There are unique phenomenologil issu that gay and bisexual men will experience when a sexual relatnship wh another man and although their experienc uld differ om that of heterosexual men, the siari pertag to mascule and sexual difficulti were adverse effects of ED are seen as more of a problem the gay muny (Asenc, Blank, Drt, & Crawford, 2009). Equally, has also been reported, acrdg to Blank (2005), that the importance of erectile functn, and the way which sexually related dysfunctn may hib or dispt timate relatnships, uld be unrstood as beg very different for gay and bisexual men.