How Are Gay Men Affected by Prostate Cancer?

It has been estimated that somewhere between 97,000-123,000 gay or bisexual men are living with a prostate cancer diagnosis in the United States alone, with roughly 39,000-74,000 of these men being in committed male-male relationships.¹ With so many gay or bisexual men living with prostate cancer, it is not surprising to learn that an emerging area of research revolves around the experience of these men during their prostate cancer battle.

Some research has suggested that gay or bisexual men may have more significant impacts on their overall quality of life during or after treatment for prostate cancer which results in a prostate cancer health disparity. Some of these differences in quality of life (when compared to heterosexual men) may stem from communication issues between a gay or bisexual individual and theirhealthcare team, as well as a larger impact on sexual functioning for gay men with prostate cancer compared to heterosexual men with the condition.

Much more research needs to be completed to determine the extent of the differences in quality of life between gay or bisexual men and heterosexual men, however, several issues have continued to appear in studies that exist so far.

Communication with your healthcare provider

A common frustration reported by gay or bisexual men with prostate cancer is a lack of open communication with their healthcare providers and a lack of information geared to couples regardless of their sexual orientation. Fear of discrimination or the reluctance of gay and bisexual men to disclose sexuality with healthcare providers can be common, leading to treatment decisions that are not as optimal for the patient. For example, one study estimated that over 20% of all gay or bisexual men between the ages of 50 and 95 were not “out” to their healthcare team. Additionally, many men who would disclose their identity as a gay or bisexual man report that their doctor failed to ask about their sexual orientation or assumed they were heterosexual or not sexually active.^1,2

If a man is not known as gay or as sexually active by their doctor, treatment options that decrease the strength of erections or remove the prostate may be pursued, both of which could have a more significant impact on quality of life for and identity for sexually active gay men than sexually active heterosexual men (to be described more in the next section on sexual functioning).³

Lack of sexual health information for gay men

Also, many gay or bisexual men report that educational materials or literature on prostate cancer are geared toward heterosexual couples, especially when discussing the needs of sexual partners and the impact on sexual functioning.^1,2 Information that is not representative of a large proportion of men struggling with a condition can lead to feelings of isolation.

These feelings can then in turn lead to depression and anxiety, or a fear of asking a healthcare team about about gay or bisexual-related health concerns. If a man is fearful of discussing these issues, they may not get addressed, and their quality of life could be severely impacted.

Changes in sexual functioning

Potentially the biggest quality of life difference between heterosexual and gay men with prostate cancer is the overall impact of impaired sexual function. Sexual side effects are very common during and after prostate cancer treatment, with erectile dysfunction and decreased sex drive frequently occurring. While the occurrence of sex-related side effects affects homosexual and heterosexual men equally, some research has suggested that these impacts may take a larger toll on quality of life in gay or bisexual men.

For example, it has been suggested that men need more rigid erections (33% more rigid according to the study) are needed for anal penetration than for vaginal intercourse.¹ For this reason, problems maintaining a very strong and continuous erection may impact gay or bisexual men more than heterosexual men. Even treatment options designed to help maintain an erection, such as medications or penile rings, may not provide a strong enough erection for gay men to continue the sexual activities they are accustomed to.

How is sexual function affected?

Further, presence of the prostate in a man receiving anal sex can contribute to sexual pleasure. If the prostate gland is removed, shrinks, or is destroyed as a result of treatment, receiving anal sex is a different experience and may no longer be as pleasurable for the man without a prostate. Additionally, radiation therapy may cause irritation or pain to the rectum, making anal sex uncomfortable or even impossible for the receiver. Several treatment options, specifically surgery, may lead to the loss of the ability to ejaculate with orgasm, which has been suggested to be more central to gay male sex than to heterosexual sex.^1,4-6

Addressing challenges specific to gay men with prostate cancer

Addressing these quality of life-impacting issues can be done in many ways, from counseling or therapy to medications and other clinical interventions. How you choose to handle these issues and who you choose to share these struggles with is completely up to you. Although it may be difficult to open up about some of these issues to your healthcare team, spouse, or intimate partners, communicating these needs may open up doors to more management options and support sources.

More research needs to be done to determine the extent of the differences in quality of life between heterosexual and gay or bisexual men with prostate cancer. However, if you are experiencing negative impacts to your quality of life, or feelings of severe depression, anxiety, or isolation, it is important to seek medical attention as soon as possible.