Topic: Sexual health concerns of gay and bisexual men with prostate cancer

Relevance: Medium-High

Quality of Writing: High

Relevance Rating Details

What is this study about?

The study looked at the attitudes, training and experiences of doctors when treating gay and bisexual people who have prostate cancer.

Why is this study important?

Prostate cancer treatment includes medications, radiation and surgeries that can affect the sexual health of patients. Side effects include leakage of urine (incontinence), erectile dysfunction, reduced sex drive and loss of ejaculate. These side effects may affect gay and bisexual men differently than heterosexual men. Radiation therapy using implants that are placed within the prostate to kill cancer cells may be harmful to sex partners during anal intercourse. Gay and bisexual men with prostate cancer also have specific psychological and emotional concerns related to the effects of treatment on their sexual health.

Certain medical options may be used to improve these sexual side effects. However, many urologists (doctors who specialize in treating the urinary and reproductive systems, including the prostate) do not routinely talk with their gay and bisexual patients about sexual health. In turn, these patients may not feel comfortable discussing sexual health concerns or seeking care. This can lead to negative health outcomes.

Researchers designed a survey of urologists across the U.S. to understand their knowledge, comfort and practice patterns when treating LGBTQ+ patients, including prostate cancer-specific care.

Study findings

Over 150 urologists were surveyed. Among the surveyed urologists, 86 percent were heterosexual, 12 percent identified as gay and less than 1 percent identified as bisexual.

Most urologists did not routinely collect information on patient sexual orientation.

• Over half (58%) did not ask about sexual orientation on intake forms.
• Over half (60%) did not ask about sexual orientation when taking a personal history.
• Most asked about sexual orientation if it was “immediately relevant to a clinical problem.”

Half of the surveyed urologists believed that knowing their patient’s sexual orientation was not necessary for the best care.

• Older physicians were more likely to believe that knowing their patient’s sexual orientation was necessary, but younger physicians were more likely to have intake forms that included sexual orientation and to directly ask about sexual orientation while taking a history.

 LGBTQ health training was limited for most of the urologists surveyed.

• Most urologists had 1-5 hours of training on LGBTQ+ health.
• Nearly 20% of respondents reported having no LGBTQ+ health training.
• Most (74%) believe more educational events on LGBTQ+ health are needed.

Knowledge and recommendations about prostate cancer issues for LGBTQ+ patients varied.

• Over half (53%) did not believe that health concerns related to prostate cancer of gay and bisexual men are different than straight men.
• Most (63.6%) believe anal stimulation of the prostate is a source of sexual pleasure. However, fewer (56%) believed that asking about sexual satisfaction after prostate cancer treatment was important for men who have anal sex.
• Most (~60%) understood that LGBTQ+ patients avoid accessing health care due to difficulty communicating with providers.
• Nearly 65% of respondents knew that gay and bisexual men are at increased risk for anal cancer.
• Only about 20% of respondents knew that the absence of ejaculation was more bothersome for gay and bisexual men than for straight men (60% reported not knowing whether this bothered their gay or bisexual patients).
• Advice about resuming sexual activity varied: one-third of urologists indicated prostate cancer patients could resume anal intercourse 4-6 weeks after treatment, one-third recommended waiting until 6-8 weeks after treatment and one-third recommended waiting 8 weeks or more after treatment.

What does this mean for me?

This study shows that not all urologists are equally knowledgeable or talk about sexual health concerns with gay or bisexual men who have prostate cancer.  

If you are a gay or bisexual man with prostate cancer, ask your doctor about their familiarity with issues around LGBTQ+ sexual health. When discussing cancer treatment, clarify potential side effects and ways to manage those issues with your doctor. If your doctor does not seem comfortable discussing these issues with you, check out our resource tab to find a list of LGBTQ+-friendly doctors and medical centers.   

References

Cavello, J. Providing a Tailored Approach to Prostate Cancer Care for Gay and Bisexual Men. The ASCO Post; October 25, 2022.

Xu AJ, Panken EJ, Gonzales-Alabastro CD, et al. Urologists and Lesbian, Gay, Bisexual, Transgender, or Queer Patients: A Survey-based Study of the Practice Patterns, Attitudes, and Knowledge Base of Urologists Toward Their Lesbian, Gay, Bisexual, Transgender, or Queer Patients. Urology. 2023 Jun 5;S0090-4295(23)00458-2.  [published online ahead of print, 2023 Jun 5]. doi:10.1016/j.urology.2023.05.019

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

Share your thoughts on this XRAY review by taking our brief survey.  

posted 9/21/23