Changes in Sexual Roles and Quality of Life for Gay Men after Prostate Cancer: Challenges for Sexual Health Providers

Abstract

Introduction Gay men with prostate cancer (GMPCa) may have differential health-related quality of life (HRQOL) and sexual health outcomes than heterosexual men with prostate cancer (PCa), but existing information is based on clinical experience and small studies. Aims Our goals were to: (i) describe HRQOL and examine changes in sexual functioning and bother; (ii) explore the psychosocial aspects of sexual health after PCa; and (iii) examine whether there were significant differences on HRQOL and sexual behavior between GMPCa and published norms. Methods A convenience sample of GMPCa completed validated disease-specific and general measures of HRQOL, ejaculatory function and bother, fear of cancer recurrence, and satisfaction with prostate cancer care. Measures of self-efficacy for PCa management, illness intrusiveness, and disclosure of sexual orientation were also completed. Where possible, scores were compared against published norms. Main Outcome Measures Main outcome measures were self-reported sexual functioning and bother on the Expanded Prostate Cancer Index. Results Compared with norms, GMPCa reported significantly worse functioning and more severe bother scores on urinary, bowel, hormonal symptom scales (Ps < 0.015–0.0001), worse mental health functioning (P < 0.0001), greater fear of cancer recurrence (P < 0.0001), and were more dissatisfied with their PCa medical care. However, GMPCa reported better sexual functioning scores (P < 0.002) compared with norms. Many of the observed differences met criteria for clinical significance. Physical functioning HRQOL and sexual bother scores were similar to that of published samples. GMPCa tended to be more “out” about their sexual orientation than other samples of gay men. Conclusions GMPCa reported substantial changes in sexual functioning after PCa treatment. They also reported significantly worse disease-specific and general HRQOL, fear of recurrence, and were less satisfied with their medical care than other published PCa samples. Sexual health providers must have an awareness of the unique functional and HRQOL differences between gay and heterosexual men with PCa.

Men's Sexual and Relational Adaptations to Erectile Dysfunction After Prostate Cancer Treatment

“…Here, partners' needs have to be taken into account (Li et al, 2016). Although there is some recognition of this in the PCa literature and in health promotion resources, there is little for male partners of men diagnosed and treated for PCa (Hart et al, 2014;Lee et al, 2013;Prostate Cancer, UK, & Stonewall Foundation, 2013;Wong et al, 2013). For both heterosexual and nonheterosexual couples alike, there is little that focuses on sex in the many ways it is practiced by our study's respondents.…”

Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations

“…It has been suggested that the effects of prostate cancer treatment on sexual function and quality of life may differ by sexual orientation. 134 Three studies 140–142 reported poorer outcomes and decreased quality of life among gay men with prostate cancer compared with heterosexual men or published norms. In contrast, a larger study among men with prostate cancer in the United States, Australia, Canada, United Kingdom, and other countries reported no significant differences in sexual function scores between heterosexual men and gay and bisexual men.…”

Racial differences in prostate cancer risk in young HIV-positive and HIV-negative men: a prospective cohort study

“…SIRs below 1 are also consistent with possible underascertainment of prostate cancer, which might stem from stigma associated with a prostate cancer diagnosis and consequences of treatment in MSM as discussed by Rosser et al (28). Factors explored in other studies include compromised sexual function following treatment in MSM (37, 38) and poorer health outcomes potentially caused by the heteronormative slant of prostate cancer treatment options (39, 40). Nonetheless, other factors may heighten prostate cancer risk among MSM, particularly androgen use (35), which was higher among young gay and bisexual adolescents in comparison to heterosexual adolescents in a US study published in 2014 (39).…”