Prostate cancer is the most common male malignancy. According to the American Cancer Society, there will be an estimated 161,360 new cases and over two million survivors in the United States in 2017. While prognosis is good for men whose prostate cancer is caught early, treatments can cause a number of side effects, including difficulties with erections, ejaculation, low desire, urinary incontinence, bowel incontinence, urination with orgasm (climacturia) and painful intercourse.

Estimates of the number of gay and bisexual (G/B) men with prostate cancer reveal that at least 5,000 G/B men are diagnosed with the disease each year and over 50,000 are survivors. Until recently, little was known about this group of survivors. There is some data to suggest that G/B men may be diagnosed at younger ages than other men. A few studies have been published reporting poorer quality of life and other psychosocial outcomes for G/B men, including worse urinary and bowel function, poorer ejaculatory functioning and greater bother caused by poor ejaculatory function. Across studies, the data differ on the degree of sexual functioning and the amount men are bothered by poor sexual functioning. In one study, G/B men were asked how their cancer had affected their sexual repertoire. Most participants reported they were less likely to be the insertive partner for sexual intercourse after prostate cancer treatment (Hart, Coon, Kowalkowski, Zhang, Hersom, Goltz…Latini, 2014).

Based on the existing research literature, G/B men report worse health-related quality of life. Similarly, many G/B men with prostate cancer describe lower treatment satisfaction compared to their heterosexual counterparts. G/B men encounter a number of challenges in accessing and navigating healthcare settings. Common perceptions of healthcare providers and settings are that G/B men are likely to receive inadequate prostate care. Many cite discomfort with the “coming out” process with health providers, lack of psychosocial support and fears of rough rectal exams by homophobic providers. Homophobia and stigma may be related to previous negative encounters in the healthcare system, including providers assuming that patients are heterosexual rather than asking about sexual identity. Race and ethnicity may contribute to additional stigma and negative healthcare encounters, as data from a recent study (Heslin, Gore, & Fox, 2008) suggests that G/B African-American men receive prostate specific antigen testing less frequently than their heterosexual and white G/B male counterparts. Thus, negative healthcare experiences are likely contributing to poorer health outcomes experienced by G/B men.

A cancer diagnosis is stressful for anyone. Receiving a cancer diagnosis in the face of a less-than-supportive medical system, limited social support, and limited knowledge about how diagnosis and treatment will impact sexual health makes that diagnosis all the more difficult. With our growing understanding of how prostate cancer and its treatment affect G/B men, attention has begun to focus on the surrounding environment of the cancer experience. In the last few years, support groups have formed in major cities in the United States and other countries, with online groups available to G/B men who live in other areas. Two versions of a guide to prostate cancer for G/B men have been published, and other books for clinicians and researchers have been published or are under development. New research has also begun to focus on partners of G/B men and how prostate cancer affects their relationship and sexual health.

As oncology social workers, we can help empower our G/B clients to have a positive medical experience during a difficult time in any man’s life. One important way we can do this is to educate our health care colleagues about the issues that may be important to G/B men and help our clients find their voice to participate in that education.

The physical environment in your institution sends an important message to G/B men about how much they are valued and cared about by your staff. The Gay and Lesbian Medical Association and the Fenway Institute have both provided recommendations on how to create a more welcoming environment through the images and text in your advertisements, the images on posters in your waiting room, the magazines you display, the language on your intake forms and many other, sometimes subtle, ways of welcoming G/B men to your clinic.

In addition, oncology social workers with training in sexual health can help G/B men find the words to communicate their needs to other health providers so they receive treatment that can improve their sexual quality of life after cancer treatment. At this year’s conference, the Sexuality SIG will offer a three-hour training that will help oncology social workers better understand the needs of G/B men and other sexual minority cancer survivors and return home with specific suggestions for partnering with clients to improve their sexual health. The training is oriented toward intermediate-to-advanced practitioners and will focus on sexual health needs of older adults, people in the LGBT community and others whose sexual health is often ignored. Participants will leave with a greater understanding of sexual health needs of their clients and strategies for acting as change agents in their institutions to improve sexual health.

References

Hart, T., Coon, D., Kowalkowski, M., Zhang, K., Hersom, J., Goltz, H., Wittmann, D., & Latini, D. (2014). Changes in sexual roles and quality of life for gay men after prostate cancer: Challenges for sexual health providers. The Journal of Sexual Medicine, 11, 2308-2317. DOI: http://dx.doi.org/10.1111/jsm.12598

Heslin, K., Gore, J., & Fox, S. (2008). Sexual orientation and testing for prostate and colorectal cancers among men in California. Medical Care, 46, 1240-1248.