The vast majority of published literature on prostate cancer (PCa), and also patient advocacy websites, often seem to overlook the needs of minority populations. Differences such as genetic vulnerability (suggested by higher incidence and death rates for African American men) or ethnic differences in male identity and how men relate to their bodies are not always addressed.
Men who have sex with men (MSM) are a minority of the population. The term was coined in the 1990s as a broad descriptive phrase that goes beyond how an individual identifies himself (e.g. gay, bisexual, homosexual, radical faerie, etc.) Doctors should not assume that prostate cancer has the same impact on them as on straight men, just as Latino men may have different issues than Japanese men. MSM are up against the norms and expectations of a predominantly straight society whether or not they have come out. Even if they are in a marriage or committed relationship, and have fathered or adopted children, their lives do not “fit” conventional straight lifestyles.
The website www.malecare.org devotes a section to the needs of MSM. It states: “Many doctors say, ‘I treat all patients the same.’ But not all patients are the same. Married and single patients have different treatment goals and expectations. Younger and older prostate cancer patients have different ways to digest their diagnosis. And, men who have sex with men have different concerns, too.”[i]
Doctors who treat PCa may not be aware that a given patient has a male partner and may be just as concerned about the sexual side effects of prostate cancer treatment. The patient may be reticent to disclose his status, or to discuss the specifics of his sexual lifestyle. Questionnaires and other treatment follow-up assessments on sexual quality of life were designed with straight men in mind, and may not adequately address the impact of PCa side effects for MSM. A recently published paper out of British Columbia by Lee et al. (2015) presents the results of having interviewed 16 post-treatment MSM on their sexual concerns.[ii] Through analysis of the content of all interviews, the following topics were identified:
- erectile, urinary, ejaculation, and orgasmic dysfunctions
- challenges to intimate relationships
- lack of MSM-specific oncological and psychosocial support for PCa survivorship.
According to the authors, “Sexual practices pre-treatment ranked in order of frequency were masturbation, oral sex, and anal sex, an ordering that prevailed post-treatment.” After treatment, due to compromised sexual function, the MSM experienced diminished sexual quality of life that, in some cases, affected their confidence when it came to meeting other men. The fact that they did not know where to turn for psychosocial support, e.g. a gay support group, made coping difficult. This is much less true for straight men who have access to support groups in their areas. The authors point out, “Penile-vaginal intercourse and erectile function have been the primary focus of sexual research and rehabilitation for men with PCa, and do not adequately reflect the sexual practices of MSM.”
We doctors, especially urologists and radiologists who work with PCa patients, should become more familiar with the sexual lifestyle of their patients who are MSM, and increase their sensitivity to how prostate cancer treatment will affect their intimate relationships, sexual quality of life, and overall lifestyle. We should be prepared to refer our MSM patients to organizations equipped to deal with their special needs, such as malecare. We should periodically review the professional literature for studies and resource development specific to the needs of MSM. In so doing, we will increase our ability to give them the best possible service, as we wish to do for all our patients.
[ii] Lee TK, Handy AB, Kwan W, Oliffe JL et al. The impact of prostate cancer treatment on the sexual quality of life for men-who-have-sex-with-men. J Sex Med 2015;12:2378-2386.