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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Let's Talk About Gay Sex: Gay & Bisexual Men's Sexual Communication with Healthcare Professionals After Prostate Cancer

Although sexual changes after prostate cancer (PCa) have specific meanings and consequences for gay and bisexual (GB) men, little is known about how GB men navigate sexual well-being support. 

We surveyed 124 GB men with PCa and 21 male partners, and interviewed a sub-sample of 46 GB men and 7 male partners, to examine GB men's experiences of sexual communication with healthcare professionals (HCPs) since the onset of PCa. GB men perceived a number of deficits in HCPs communication: medical support dominated sexual and psychological support; heterosexuality of GB patients was often assumed; sexual orientation disclosure was problematic; and GB men perceived rejection or lack of interest and knowledge from a majority of HCPs with regard to gay sexuality and the impact of PCa on GB men. Facilitators of communication were acknowledgement of sexual orientation and exploration of the impact of PCa on GB men. 

In order to target improved support for GB men with PCa, it is concluded that HCPs need to address issues of hetero-centricism within PCa care by improving facilitation of sexual orientation disclosure, recognising that GB men with PCa might have specific sexual and relational needs, and increasing knowledge and comfort discussing gay sexuality and gay sexual practices.

Purchase full article at:   http://goo.gl/N5ZT38

By:  Rose D1, Ussher JM1, Perz J1.

• 1Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, Australia. 
• Eur J Cancer Care (Engl). 2016 Feb 26. doi: 10.1111/ecc.12469.

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History of Gonorrhea & Prostate Cancer in a Population-Based Case-Control Study in Mexico

Abstract

We evaluated the association between a history of sexually transmitted diseases (STDs) and the risk for prostate cancer (PC) among Mexican males.

METHODS:

PC incident cases (n=402) that were identified at six public hospitals in Mexico City were matched by age (±5 years) with 805 population controls with no history of PC. By face-to-face interview, we obtained information about sexual history, previous STDs, sociodemographic characteristics, and familial history of PC. An unconditional logistic regression model was used to estimate the risk for PC.

RESULTS:

A total of 16.6% of men reported having had at least one previous STD, and the most frequently reported STD was gonorrhea (10.5%). After adjusting by PC familial history, the history of STD was associated with a two-fold greater risk of PC: odds ratio (OR)=2.67; 95% confidence interval (95% CI=1.91-3.73). When each STD was evaluated separately, only gonorrhea was associated with a significant increase in PC risk (OR=3.04; 95% CI=1.99-4.64). These associations were similar when we stratified by low-risk PC (Gleason <7) and high-risk PC (Gleason ≥7).

CONCLUSION:

These results confirm that STDs, and particularly gonorrhea, may play an etiological role in PC among Mexican males, which is consistent with a previous report from a multiethnic cohort.

Purchase full article at:   http://goo.gl/yzt9KK

By:   Vázquez-Salas RA1, Torres-Sánchez L2, López-Carrillo L1, Romero-Martínez M1, Manzanilla-García HA3, Cruz-Ortíz CH3, Mendoza-Peña F4, Jiménez-Ríos MÁ5, Rodríguez-Covarrubias F6, Hernández-Toríz N7, Moreno-Alcázar O8.

• 1Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico.
• 2Instituto Nacional de Salud Pública (INSP), Av. Universidad 655, Col. Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico. Electronic address: ltorress@insp.mx.
• 3Hospital General de México, Dr. Balmis 148, Col. Doctores, Deleg. Cuauhtémoc, 06726 México, D.F., Mexico.
• 4Hospital Regional "Lic. Adolfo López Mateos" (ISSSTE), Av. Universidad 1321, Col. Florida Deleg. Álvaro Obregón, 01030 México, D.F., Mexico.
• 5Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 México, D.F., Mexico.
• 6Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Av. Vasco de Quiroga 15, Col. Belisario Domínguez, Col. Sección XVI, Deleg. Tlalpan, 14080 México, D.F, Mexico.
• 7Hospital de Oncología, Centro Médico Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), Av. Cuauhtémoc 330, Col. Doctores, Deleg. Cuauhtémoc, México, D.F., 06720, Mexico.
• 8Hospital General Regional No. 1. "Carlos MacGregor Sánchez Navarro" (IMSS), Eje 2 Pte 222, Col. Del Valle Centro, Deleg. Benito Juárez, 03100 México, D.F., Mexico.

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The Health Effects of Masculine Self-Esteem Following Treatment for Localized Prostate Cancer among Gay Men

PURPOSE:

To identify factors associated with masculine self-esteem in gay men following treatment for localized prostate cancer (PCa) and to determine the association between masculine self-esteem, PCa-specific factors, and mental health factors in these patients.

METHODS:

A national cross-sectional survey of gay PCa survivors was conducted in 2010-2011. To be eligible for the study, men needed to be age 50 or older, reside in the United States, self-identify as gay, able to read, write, and speak English, and to have been treated for PCa at least 1 year ago. One hundred eleven men returned surveys.

RESULTS:

After simultaneously adjusting for the factors in our model, men aged 50-64 years and men aged 65-74 years reported lower masculine self-esteem scores than men aged 75 years or older. Lower scores were also reported by men who reported recent severe stigma. Men who reported feeling comfortable revealing their sexual orientation to their doctor reported higher masculine self-esteem scores than men who were not. The mental component score from the SF-12 was also positively correlated with masculine self-esteem.

CONCLUSION:

PCa providers are in a position to reduce feelings of stigma and promote resiliency by being aware that they might have gay patients, creating a supportive environment where gay patients can discuss specific sexual concerns, and engaging patients in treatment decisions. These efforts could help not only in reducing stigma but also in increasing masculine self-esteem, thus greatly influencing gay patients' recovery, quality of life, and compliance with follow-up care.

Purchase full article at:   http://goo.gl/7IDl6T

By:    Allensworth-Davies D1, Talcott JA2, Heeren T3, de Vries B4, Blank TO5, Clark JA6,7.

• 1 School of Health Sciences, College of Sciences and Health Professions, Cleveland State University , Cleveland, Ohio.
• 2 Center for Health Care Quality and Outcomes Research, Continuum Cancer Centers of New York , New York, New York.
• 3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts.
• 4 Gerontology Program, San Francisco State University , San Francisco, California.
• 5 Human Development and Family Studies, University of Connecticut , Storrs, Connecticut.
• 6 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital , Bedford, Massachusetts.
• 7 Department of Health Policy and Management, Boston University School of Public Health , Boston, Massachusetts. 

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Impact of Prostate Cancer Treatment on the Sexual Quality of Life for Men Who Have Sex with Men

With earlier prostate cancer (PCa) diagnosis and an increased focus on survivorship, post-treatment sexual quality of life (QoL) has become increasingly important. Research and validated instruments for sexual QoL assessment based on heterosexual samples have limited applicability for men-who-have-sex-with-men (MSM).

We aimed to create a validated instrument for assessing sexual needs and concerns of MSM post-PCa treatment. Here we explore post-PCa treatment sexual concerns for a sample of MSM, as the first part of this multi-phase project.

Individual semi-structured interviews were conducted with 16 MSM face-to-face or via Internet-based video conferencing. Participants were asked open-ended questions about their experiences of sexual QoL following PCa. Interviews were recorded, transcribed verbatim, uploaded to NVivo 8^TM , and analyzed using qualitative methodology.

We have conducted semi-structure qualitative interviews on 16 MSM who were treated for PCa. Focus was on post-treatment sexual concerns.

The following themes were inductively derived: (i) erectile, urinary, ejaculation, and orgasmic dysfunctions; (ii) challenges to intimate relationships; and (iii) lack of MSM-specific oncological and psychosocial support for PCa survivorship. Sexual practices pre-treatment ranked in order of frequency were masturbation, oral sex, and anal sex, an ordering that prevailed post-treatment. Sexual QoL decreased with erectile, urinary, and ejaculation dysfunctions. Post-treatment orgasms were compromised. Some single men and men in non-monogamous relationships reported a loss of confidence or difficulty meeting other men post-treatment. Limited access to targeted oncological and psychosocial supports posed difficulties in coping with PCa for MSM.

The negative impact on sexual QoL can be severe for MSM and requires targeted attention. Penile-vaginal intercourse and erectile function have been the primary focus of sexual research and rehabilitation for men with PCa, and do not adequately reflect the sexual practices of MSM. Our findings suggest that future research dedicated to MSM with PCa is needed to incorporate their sexual practices and preferences specifically into treatment decisions, and that targeted oncological and psychosocial support services are also warranted. Lee TK, Handy AB, Kwan W, Oliffe JL, Brotto LA, Wassersug RJ, and Dowsett GW. The impact of prostate cancer treatment on the sexual quality of life for men-who-have-sex-with-men.

Purchase full article at:   http://goo.gl/IefZQt

By:  Lee TK1, Handy AB2, Kwan W1, Oliffe JL3, Brotto LA2, Wassersug RJ4, Dowsett GW5.

• 1British Columbia Cancer Agency, Fraser Valley Cancer Centre, Surrey, BC, Canada.
• 2Department of Obstetrics and Gynaecology, Diamond Health Care Centre, University of British Columbia, Vancouver, BC, Canada.
• 3Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada.
• 4Department of Urologic Sciences, Gordon and Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, BC, Canada.
• 5Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia. 

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Malignant Priapism: Penile Metastasis Originating on a Primary Prostate Adenocarcinoma

Below:  Coronal sulcus inflammatory nodules

Malignant priapism is a definition invented in 1938 by Peacock, defined as a persistent erection, not related with sexual activity, caused by cavernous sinus and associated venous systems invasion with malignant cells. Penile secondary lesions are rare entities. Primary locations are usually the pelvic cavity organs, namely the prostate and the bladder as the most common ones. Priapism as a first manifestation of these kinds of lesions is even rarer. The aim was to present a 52-year-old patient harboring a penile metastasis that originated in the primary prostate adenocarcinoma, manifesting itself as a “common” priapism. The patient referred to the emergency room presenting with a priapism and nodules at the coronal sulcus, without previous similar episodes. His evolution until properly diagnosed was catastrophic with multiple lymph nodes, bone and organ involvement, and with his demise soon after from serious bleeding and congestive heart failure, almost 2 months after he first came to the emergency room. We review the literature concerning malignant priapism, diagnosis, and current treatment and survival perspectives.

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