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It is not known how many GBM are offered rehabilitation, what is offered, what they choose, and, most importantly, outcomes. Prostate cancer and its treatment have significant effects on mental health, specifically anxiety and depression, 17 , 87 as well as quality of life. Case studies of GBM with prostate cancer confirm significant mental health challenges, posttreatment. In a qualitative study of 14 heterosexual men and 4 homosexual men, prostate cancer and erectile dysfunction were identified as major threats to masculine identity.

How prostate cancer treatment affects the identity of GBM as gay or bisexual does not appear to have been studied, directly. In turn, cessation of sex may influence other parts of identity, such as a sense of being valued, valuable, or old. Compared to heterosexuals, GBM experience less familial 43 , 44 , 77 , 80 , 81 and social support. The effects of such support have not been evaluated. Most of the men reported erectile dysfunction, lost sexual confidence, and decreased sexual activity. Couple's engagement in intentional sex, the patients' acceptance of erectile aids, and the partners' interest in sex aided the recovery of sexual intimacy.

We found three case reports documenting effects of prostate cancer on GBM couples: His partner reported coping with these changes and reduced spontaneity through increased masturbation to pornography, which was not part of their lives, prediagnosis. Given gender differences, the literature on female partners of men with prostate cancer should be extrapolated to male partners with extreme caution.

For example, some heterosexual studies suggest that female partners are less concerned about sexuality than the patients, , which may not generalize to male partners. Conversely, male partners may have unique concerns such as fear of infectivity that female partners may not experience.


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In addition, prostate cancer's impact on single GBM 77 and casual sex partners 5 , 17 needs research. Single GBM may be more likely to experience problems in care provision and reduced social support, 35 challenges in dating, coming out as living with prostate cancer, fear of rejection, and diminished hope of finding a long-term relationship.

We could find no studies assessing the effects of sexual rehabilitation treatment on GBM, so we briefly summarize the literature on treatment effectiveness in predominantly heterosexual men. The effectiveness of individual treatments has been evaluated. In addition, sildenafil may be ineffective in the first 9 months, postsurgery.

Prostate Cancer in Gay, Bisexual, and Other Men Who Have Sex with Men: A Review

Like the literature on GBM, Latini et al. In randomized controlled trials, a four-session psychoeducation intervention showed significant improvements in male overall distress and sexual function at 3 months. Recruitment of GBM in meaningful numbers for study is also a barrier, exacerbated by professionals reluctant to take detailed sexual histories, and clinical systems reluctant to collect data on sexual orientation or gender of sexual partners.

This leaves GBM with prostate cancer as an invisible, geographically dispersed hard-to-recruit population. In addition, prostate cancer remains a stigmatized disease in the wider population and within the gay community. Electronic medical records that capture data on sexual orientation and the recent development of online support groups for GBM with prostate cancer are two promising ways to overcome these structural challenges.

In addition, heterocentric definitions of functioning limited to penetrative sex are problematic. Physiologically, anal penetration requires a greater degree of penile rigidity than vaginal penetration, 28 , 30 which potentially explains the poorer outcomes of prostate cancer treatment for GBM.

Population-appropriate measures and definitions need to be developed before the effects of prostate cancer treatment in GBM can be enumerated. Six directions for future research are identified.

First, methodological research is needed to identify ways to locate, recruit, and retain GBM with prostate cancer in studies and to develop population-appropriate definitions and measures. Second, more formative research is needed. In particular, in-depth examination of the effects of treatment on sexual functioning behavior and identities will advance a comprehensive sexological understanding of the experience of prostate cancer in GBM.

Third, empirical studies to quantify the prevalence and incidence of sexual problems and effects of treatment by treatment type will be critical to informing clinical care. Fourth, comparative studies of treatment preferences for GBM and heterosexual men should confirm whether GBM are more, as, or less likely than heterosexuals to choose surgical intervention. Fifth, intervention studies to address the rehabilitation needs of GBM with prostate cancer are needed to develop evidence-based interventions tailored for this population.

Finally, the training needs of urologists, surgeons, oncologists, and other specialists providing services to GBM with prostate cancer need to be identified and curricula developed to ensure culturally competent providers capable of addressing the sexual health needs and care of this population.

GBM appear to be screened for prostate cancer less than other men, diagnosed with prostate cancer at about the same rate, but have poorer sexual function and quality-of-life outcomes. Part of the problem is lack of sexual rehabilitation treatment for GBM, and part is the lack of research to guide development of appropriate treatment. While GBM may experience similar challenges following treatment to other men, because the sexual context is different, treatment outcomes appear worse. Substantial research will be needed to address this health disparity.

CA; PI: The authors warmly acknowledge Derek Johnson project coordinator , James DeWitt research assistant , and Angelique Lele executive assistant in helping to develop this article. The homosexuality estimates are based on pooled estimates from seven nationally representative surveys, while the couple estimates are based on three older studies.

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Assessing localized prostate cancer posttreatment quality of life outcomes among gay men. Unpublished thesis. Boston University School of Public Health, National Center for Biotechnology Information , U. LGBT Health. Find articles by B. Simon Rosser. Find articles by Enyinnaya Merengwa. Benjamin D. Find articles by Benjamin D. Find articles by Alex Iantaffi. Find articles by Gunna Kilian. Find articles by Nidhi Kohli. Badrinath R. Find articles by Badrinath R.

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Corresponding author. Address correspondence to: Copyright , Mary Ann Liebert, Inc. Abstract Purpose: Key words: Results The literature on prostate cancer in GBM is sparse. The epidemiology of prostate cancer in GBM Prostate cancer is the second most common cancer among men in the United States, with 2,, US men living with prostate cancer in Quantitative studies We could find only four published studies 4 , 10 , 15 , 18 and one unpublished quantitative study of prostate cancer in GBM. Stigma The sexual effects of prostate cancer carry a stigma leading some GBM to conclude they are sexually undesirable or less than other GBM.

Mental health and quality of life Prostate cancer and its treatment have significant effects on mental health, specifically anxiety and depression, 17 , 87 as well as quality of life. Identity challenges In a qualitative study of 14 heterosexual men and 4 homosexual men, prostate cancer and erectile dysfunction were identified as major threats to masculine identity. Social support Compared to heterosexuals, GBM experience less familial 43 , 44 , 77 , 80 , 81 and social support.

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Sexual rehabilitation treatment in GBM We could find no studies assessing the effects of sexual rehabilitation treatment on GBM, so we briefly summarize the literature on treatment effectiveness in predominantly heterosexual men. Conclusion GBM appear to be screened for prostate cancer less than other men, diagnosed with prostate cancer at about the same rate, but have poorer sexual function and quality-of-life outcomes.

Author Disclosure Statement No competing financial interests exist. References 1.