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

Purpose:

Prostate cancer in gay, bisexual, and other men who have sex with men (GBM) is an emerging medical and public health concern. The purpose of this review is to summarize the literature on prostate cancer in GBM, including its epidemiology, clinical studies, and anecdotal reports.

Methods:

In 2015, we undertook a structured literature review of all studies from 2000 to 2015.

Results:

Despite prostate cancer being the most common cancer in GBM, the main finding of this review is that prostate cancer in GBM is very under-researched. With only 30 published articles in English (a rate of 1.9 articles per year), most of the literature is limited to case studies or anecdotal reports. There is some evidence of a link between human immunodeficiency virus (HIV)-positive status and prostate cancer, with early studies showing HIV infection as a risk factor and more recent studies as it being protective. Antiretroviral treatment appears protective. Globally, only four quantitative studies have been published. Based on this admittedly limited literature, GBM appear to be screened for prostate cancer less than other men and are diagnosed with prostate cancer at about the same rate, but have poorer sexual function and quality-of-life outcomes.

Conclusion:

Methodological challenges to advancing research include challenges in subject identification, recruitment, heterocentric definitions of dysfunction based on vaginal intercourse and penetrative sex, and inappropriate measures. Six future directions, to advance the study of the effects of prostate cancer in GBM and to improve treatment, are detailed...

[H]eterocentric definitions of functioning limited to penetrative sex are problematic. While DSM-5¹¹⁵ defines “sexual dysfunction” as “a clinically significant disturbance in a person's ability to respond sexually,” erectile functioning in prostate cancer treatment is typically operationalized as “sufficient for vaginal penetration.”^5,116,117 This gold standard is irrelevant for sex between men. 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...

Full article at:   http://goo.gl/Y7ItUl

By:  B.R. Simon Rosser, PhD, MPH, ¹ Enyinnaya Merengwa, MD, MPH, CPH,² Benjamin D. Capistrant, ScD,¹ Alex Iantaffi, PhD,¹ Gunna Kilian,¹ Nidhi Kohli, PhD,³ Badrinath R. Konety, MD, MBA,⁴ Darryl Mitteldorf, MSW, MPA,⁵ and William West, PhD⁶

¹Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.

²Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

³Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota.

⁴Department of Urology, University of Minnesota, Minneapolis, Minnesota.

⁵Malecare Cancer Support, New York, New York.

⁶Department of Writing Studies, University of Minnesota, Minneapolis, Minnesota.

Corresponding author.

Address correspondence to:, B.R. Simon Rosser, PhD, MPH, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454

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