Gay and Bisexual Men With Prostate Cancer Have Unique Needs

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Institution Partners | Cancer Centers | <b>Allina Health System</b>

Gay and bisexual men with prostate cancer may have different needs that need to be addressed with health care providers as they go through treatment and beyond.

Gay and bisexual men with prostate cancer represent a patient population with unique needs related to their health before a cancer diagnosis, quality of life and outcomes after treatment, an expert said.

Dr. Badrinath R. Konety, Elizabeth and Eugene Leonard Chair, president of Allina Health Cancer Institute and chief academic officer of Allina Health System in Minneapolis, Minnesota, told CURE® that bisexual and gay men are an often-understudied patient population because they don’t typically declare their sexual orientation to their health care providers. In addition, he said that health care systems are not set up to ask patients for this information, although more systems are integrating these types of questions.

Even if a health care system asks patients for their sexual orientation, findings from a study that Konety and his colleagues conducted demons

trated that men may be hesitant to share this information with their doctors.

“They’re worried that the nature of the treatment and the conversation will change,” Konety said. “Oftentimes, they feel that most providers only have a heterosexual understanding, so it’s hard for them to think otherwise. And some (men) have even expressed that when we discuss (sexual orientation), when somehow the providers find out, they feel uncomfortable because they, themselves, are heterosexual, (and) they don’t know how to react, I suppose.”

In fact, the National Institute on Minority Health and Health Disparities, which is part of the National Institutes of Health, lists sexual and gender minority groups as a population that experiences health disparities. This has led to researchers receiving grant funding to conduct studies in this patient population.

Baseline Comorbidities

There are some comorbidities, or the presence of two or more diseases at the same time, that are common in gay and bisexual men with prostate cancer, Konety explained.

“(These include) difficulty or lack of self-care and higher incidence of substance abuse in some of these (patients),” Konety added. “And this feeling of being on the margins, that may even let them not be as forthcoming in providing information about themselves or even seeking care for some of these things. And there's higher incidence of depression and less social support.”

The combination of these comorbidities along with receiving a prostate cancer diagnosis may make patients’ experience with the disease different than those of heterosexual men.

“They're going through a very life changing procedure or treatment for — just the fact that having cancer is concerning,” Konety said. “Now, on top of that, the aftereffects of treatment are concerning. And if this directly affects your identity as a person; it really puts you in a very bad spot. So there's lots of nuances to this that may be different than for heterosexual men that we need to be aware of.”

Treatment Effects

Sexual identity in gay and bisexual men is an important factor in their lives, he said. One example of something that impacts gay and bisexual men with prostate cancer differently than heterosexual men is climacturia, or orgasm-associated incontinence, which can occur as a result of surgery or radiation.

“That was one of our earlier findings in some of our research, is that some of these unique things that are not as highlighted in the literature and had been described, but nobody had paid attention on how to counsel men, heterosexual men about prostate cancer therapy,” Konety said. “We talk a lot about loss of erectile function, incontinence, but we don’t specifically talk about climacturia.”

Hormone therapy can also impact mood and depression, among other factors of life.

“If you already have a population of men who are vulnerable to things like depression, as well may even have underlying depression that may not have been diagnosed, this compounds the issue,” Konety said.

He added that health care providers should be proactive to discover if a gay or bisexual patient with prostate cancer is depressed at the time of cancer diagnosis and to act accordingly, either by adding antidepressants to hormone therapy. Another option may be intermittent hormone therapy, which gives patients breaks and allows their bodies to reacclimate for a period of time.

The sex lives of gay and bisexual men with prostate cancer may be affected during and after treatment, Konety said. For example, erectile dysfunction after prostate surgery may impact whether the patient can continue being a top or bottom.

“Let’s say there are tops. Now you could argue, ‘OK, well, now, if you’re erectile function is poor after prostate surgery, could you just revert and become bottoms,’” Konety said. “And it’s not that simple because apparently that’s also part of their identity. And you can’t simply just switch around, so that creates a lot of angst and may fracture relationships.”

Support Groups and Advocacy

As awareness of the needs of bisexual and gay men with prostate cancer increases, more support groups and online resources are becoming available for patients to discuss issues and connect with other patients.

In addition, Konety advised patients that if their health care provider is not meeting their unique needs, they should seek out another cancer team that can do so.

“If their provider is not aware of the nuances or what may be different, reach out to experts and people who are more experienced in the field,” Konety said. “If they feel uncomfortable with the interaction with the provider once the provider is aware that they're gay, they may want to think about reestablishing a relationship elsewhere. The most important thing is for them to assert their unique needs, make people aware of it, and make sure people understand and address that in a non-discriminatory way. And if the provider can help them with that, then there are others who can.”

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