The Sexual Functioning of Gay and Bisexual Men Following Prostate Cancer Treatment: Results from the Restore Study

Abstract

Prostate cancer is the second most common cancer in gay, bisexual, and other men who have sex with men (GBM). Few studies have assessed the effects of treatment on GBM's sexual behavior. For an online survey, 193 gay and bisexual men with prostate cancer were recruited from the North American's largest online cancer support group. Sexual functioning was measured using the Expanded Prostate Cancer Index Composite (EPIC) and a tailored Gay Sexual Functioning Inventory (GSFI). GBM have worse EPIC urinary and hormonal function and worse hormonal bother, but better sexual function and bother scores than published norms. In the GSFI, two-thirds of participants described their sexual functioning, post-treatment, as fair to poor. Only 22% reported erections sufficient for insertive anal sex. For receptive anal sex, one-third met criteria for anodyspareunia. Over half reported urination problems during sex or at orgasm. Erectile difficulties were common, severe, and a reason cited for not using condoms. Three men HIV seroconverted post-prostate cancer treatment. Differences in function and bother scores were observed by type of treatment, age, race/ethnicity, sexual orientation, but not relationship status. Sexual functioning significantly predicted long-term mental and physical health. GBM scored significantly worse on mental health and better on physical health than published norms. Sexual recovery after prostate cancer treatment is problematic for most GBM. Research to develop more effective sexual recovery, tailored to the needs of GBM treated for prostate cancer, is needed. Six implications for clinicians treating GBM with prostate cancer are identified.

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

“…However, the culturally nonspecific health care and poor social support GBM experience in prostate cancer rehabilitation may compound with the comorbidities and poor HRQOL experienced by people living with HIV to prevent successful rehabilitation after prostate cancer. Thus, comprehensive, culturally competent care, as well as social support interventions that decrease patient isolation and discrimination, may be particularly important for GBM with HIV. Our findings suggest that GBM living with HIV may need increased support after prostate cancer treatment.…”

“…The multivariable model included covariates identified in previous literature as associated with HIV status and sexual and urinary outcomes after prostate cancer: age, race, type of prostate cancer treatment, relationship status, and preferred role in sex . Because the physical and mental comorbidities assessed in our study may lie on the causal pathway between HIV status and HRQOL, they were not included in models.…”

“…While sexual and urinary side effects are common for all men undergoing treatment for prostate cancer, a growing body of literature suggests that GBM experience functional limitations at a higher rate or experience greater distress in response to these limitations compared with prostate cancer survivors in general . GBM report worse urinary, hormonal, and bowel function than published norms for general samples of prostate cancer survivors .…”

“…We used a cross‐sectional survey of GBM prostate cancer survivors to examine the association between HIV status and HRQOL . We hypothesized that, in the context of the relative isolation and discrimination experienced by GBM, prostate cancer and HIV form a syndemic, or synergistic interaction resulting in poorer HRQOL among GBM with both conditions compared with HIV‐negative GBM with prostate cancer (the “synergistic burden” hypothesis).…”

Addressing Participant Validity in a Small Internet Health Survey (The Restore Study): Protocol and Recommendations for Survey Response Validation

“…The third aim, to conduct a cross-sectional, Web-based, quantitative survey assessing GBM prostate cancer survivor’s sexual functioning and rehabilitation needs following treatment, is the focus of this report. The core components of the Web-based survey included the following domains: eligibility screener, consent process, demographic questionnaire, sexual identification, prostate cancer treatment history, measures of sexual functioning, an HIV/ sexually transmitted infection status and risk inventory, a section on primary relationships, measures of physical and mental health, alcohol and tobacco use, and a tailored needs assessment of what GBM with prostate cancer want in rehabilitation [ 26 ].…”