Health‐related quality of life by human immunodeficiency virus status in a cross‐sectional survey of gay and bisexual prostate cancer survivors

Abstract

Objective Prostate cancer is the most common invasive cancer in gay and bisexual men (GBM). Despite the unique sexual and urinary concerns of this group, studies of prostate cancer rehabilitation have primarily focused on heterosexual men. GBM also have high prevalence of human immunodeficiency virus (HIV), which may be associated with lower health‐related quality of life (HRQOL). We examined the association between HIV status and HRQOL in a cohort of GBM with prostate cancer. Methods Data from the Restore study, a cross‐sectional online survey of GBM treated for prostate cancer, were used to examine this association. The Expanded Prostate Cancer Index Composite (EPIC) assessed function, bother, and summary measures in four domains: urinary, sexual, bowel, and hormone. Overall physical and mental HRQOL was assessed using the Short‐Form Health Survey (SF‐12). Multivariate analysis of variance and linear regression were used to evaluate the association between HIV status and HRQOL scores after adjustment for demographic and sexual characteristics. Results Of 192 participants, 24 (12.4%) reported an HIV diagnosis. After adjustment for covariates, HIV‐positive status was associated with lower scores on the EPIC urinary (mean difference [MD]: −13.0, 95% CI, −21.4 to −4.6), sexual (MD: −12.5, 95% CI, −21.9 to −3.2), and bowel (MD: −5.9, 95% CI, −11.7 to −0.2) domains. No significant associations were observed between HIV status and other outcomes. Conclusions HIV status may be associated with poorer urinary, sexual, and bowel HRQOL in GBM prostate cancer survivors.

Health outcomes of sexual and gender minorities after cancer: a systematic review

“…Overall, MSM reported more genitourinary challenges than heterosexual peers, including worse urinary and bowel function, lack of ejaculation, changes to erectile function, climacturia, pain during anal sex, penile shortening, loss of libido, and less frequency of sexual activity, although one study demonstrated better sexual function in MSM diagnosed with prostate cancer than that reported in the literature [ 34 – 37 ]. MSM with HIV reported more significant detrimental effects of treatment than MSM without HIV [ 38 ]. One study showed that MSM had greater sexual dysfunction after bicalutamide monotherapy compared to heterosexual peers [ 39 ].…”

Every urologist and oncologist should know about treating sexual and gender minority prostate cancer patients: translating research findings into clinical practice

“…Four subgroups of SGM appear most at risk of poorer outcomes. First, HIV-positive patients score worse on EPIC sexual and urinary subscales compared to HIV-negative patients, post-treatment (28). Second, when we compared Restore-1 participants by age, similar to heterosexual patients, the older cohorts scored worse on SF-12 scores for mental health and physical health (P<0.05).…”

“…First, we conducted in-depth qualitative telephone interviews with 30 prostate cancer patients and nine partners or caregivers (23)(24)(25). Then, we conducted an online quantitative survey with 192 gay and bisexual and one transgender prostate cancer patients/ survivors living in North America (26)(27)(28)(29)(30)(31)(32). Participants were recruited from the largest online cancer support network providing groups for SGM prostate cancer patients.…”

Health Outcomes of Sexual and Gender Minorities After Cancer: A Scoping Review

“…MSM reported more genitourinary challenges than heterosexual peers, including worse urinary and bowel function, lack of ejaculation, changes to erectile function, climacturia, pain during anal sex, penile shortening, loss of libido, and less frequency of sexual activity [37,50,51]. MSM with HIV reported more signi cant detrimental effects of treatment than MSM without HIV [44]. One study showed that MSM had greater sexual dysfunction after bicalutamide monotherapy compared to heterosexual peers [43].…”