Same Cancer, Different Journey

Gay and bisexual men with prostate cancer may have unique needs that present challenges to doctors and health systems in the era of "patient-centered" care. In order to provide patient-centered care, a doctor must understand their patients' knowledge, perspective, cultural perspectives, and treatment preferences.

For people to be partners in their own care, they need to trust their provider with personal information, feel respected, and be understood. Decades of research has shown that LGBTQ+ people often face stigma and other barriers that impact their healthcare. This results in health disparities, or differences.

Is prostate cancer different for gay men?

While the LGBTQ+ community has worked for decades to advance our identities as "more than just sex," we are still faced with an identity that is framed by our larger society and is still labeled as different. As gay men move through adolescence, we develop an identity and an understanding of our own sexuality in relation to other gay or bisexual men. Gay men have both an individual and collective, or group, identity.

For gay and bisexual men, prostate cancer makes this clear. As gay men, we are more than our sexual lives. But there is no doubt that, for most of us, our sexuality and how we see ourselves sexually is a central part of our identity and self-concept. A prostate cancer diagnosis, and what happens after, can change all that and call into question how we see ourselves.

More questions than answers?

For people who are not in the LGBTQ+ community, it may be a difficult concept to understand. Do heterosexual people who are faced with a challenge to their sexual selves suddenly see themselves as fundamentally different? Until you are forced to face your sexuality and question it in relation to social norms, you do not have to critically examine the role of sexuality in framing your personal identity, potential group membership, sexual desire, or sex behavior.

In this way, prostate cancer and its treatment can be somewhat of an equalizer, regardless of sexual orientation. With prostate cancer, gay men, as well as heterosexual men, are confronted with an altered sense of self, a changed ability to engage in sexual behavior, and a loss of what makes them feel "like a man."

To date, most of the existing research, information, and reports of healthcare provider experience have been about heterosexual men and their experiences with prostate cancer.

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A new resource

A book published in 2018, Gay & Bisexual Men Living With Prostate Cancer: From Diagnosis to Recovery, examines some of these important differences. This book compiles 20 chapters that can appeal to many different types of readers. In short, there is something for everyone, including:

• Gay men who fear they may be at increased risk of prostate cancer
• Gay men who are newly diagnosed
• Partners of men with prostate cancer
• Researchers and other practitioners

Also included is a helpful glossary that a newly diagnosed person would do well to peruse first before diving into the book.

Regardless of how much each article focuses on personal experience or narrative of a prostate cancer journey, or on summarizing research, each chapter has unique insights to offer and supports an overall theme. The central theme is that the prostate cancer journey is likely very different for gay men than it is for our heterosexual brothers, fathers, and friends.¹

Ways that the prostate cancer journey may be different for gay men, compared to heterosexual men, include:¹

• Differences in relationships
• Differences in sexual experiences and meaning of sex to personal identity
• Differences in emotional impact and quality of life

How are gay men’s relationships different?

Another unique perspective is offered by BR Simon Rosser as he relates aspects of his own personal story. A situation that is unique to gay couples (although not all gay couples), is reflected in the author's account of his own diagnosis, even though he had gone through his partner's prostate cancer diagnosis 8 years prior.

He notes that even though his partner had gone through this, he still felt a sense of isolation: “It’s my body, my result, and in that sense, it’s a unique door that I must go through by myself.”¹

While it may not seem obvious, gay men experience sex in relationship to their sexual partner differently than heterosexual men. Gay men are familiar with how sex feels for another man. Since men have the same sexual “equipment” and sexual response, two men having sex together are more likely in tune with what their partner is feeling or not feeling based upon response and signals that they recognize in themselves.

So, what about sex?

One of the authors, Ross Henderson, asks questions that clearly represent a difference in the gay male perspective: “What about anal sex? Penetrative sex? Receptive sex? How will the absence of semen affect my orgasm? How can you reach orgasm with a flaccid penis? Will I still be a sexual man? Will I feel attractive to other men?”¹

For example, men are used to “seeing” their arousal as they are feeling it. Thus, if they don’t see their male sex partner being aroused while they are having sex, they may feel that they are not enjoying the sexual activity. For gay men, an erection may signal to another gay man “arousal, attraction, interest and pleasure.” Its loss may signal a loss of perceived sexual desirability.¹

Men who have erectile dysfunction, regardless of the reason, may be concerned that their partner will think they are “faking it.” This may be the case even if they are feeling sexual excitement and have an orgasm. As well, heterosexual men may not be as concerned about the loss of their ability to ejaculate if they are still able to achieve orgasm. But many gay men feel a sense of loss of not having ejaculated as the visible “proof” of their sexual pleasure.

More than just sex

One chapter presents very interesting data on the emotional reactions and quality-of-life differences between radiation therapy and radical prostatectomy. While it is well known that many people experience ED as a result of their treatment for prostate cancer, there is less acknowledgment of the loss of libido or sexual desire.

Gay men who have radiation therapy may be concerned about long-term damage to their rectal tissue due to proximity to the prostate. This can result in loss of sensitivity and/or pain during receptive anal sex.

The overall sense of loss that comes with prostate cancer is a shared one, whether the person is gay or heterosexual. It is not just an inhibition of the ability to seek and get sexual pleasure or a change in levels of intimacy. It is a loss of the sense of self as a sexual being.

Similarly, both gay and heterosexual men may experience a loss of their sense of masculinity as a result of prostate cancer treatment. But research has shown that gay men with prostate cancer have lower rates of masculine self-esteem than their heterosexual counterparts.¹

Dealing with these profound changes in one's physical health, self-image, emotions, and relationships can become overwhelming. Reading about other men's experiences and how they are able to overcome their fears and continue to lead fulfilling lives is so important to those of us who are beginning our journey or are confronted with challenging detours.