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The Sexual Functioning of Gay and Bisexual Men Following Prostate Cancer Treatment: Results from the Restore Study

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Abstract

Prostate cancer is the second most common cancer in gay, bisexual, and other men who have sex with men (GBM). Few studies have assessed the effects of treatment on GBM’s sexual behavior. For an online survey, 193 gay and bisexual men with prostate cancer were recruited from the North American’s largest online cancer support group. Sexual functioning was measured using the Expanded Prostate Cancer Index Composite (EPIC) and a tailored Gay Sexual Functioning Inventory (GSFI). GBM have worse EPIC urinary and hormonal function and worse hormonal bother, but better sexual function and bother scores than published norms. In the GSFI, two-thirds of participants described their sexual functioning, post-treatment, as fair to poor. Only 22% reported erections sufficient for insertive anal sex. For receptive anal sex, one-third met criteria for anodyspareunia. Over half reported urination problems during sex or at orgasm. Erectile difficulties were common, severe, and a reason cited for not using condoms. Three men HIV seroconverted post-prostate cancer treatment. Differences in function and bother scores were observed by type of treatment, age, race/ethnicity, sexual orientation, but not relationship status. Sexual functioning significantly predicted long-term mental and physical health. GBM scored significantly worse on mental health and better on physical health than published norms. Sexual recovery after prostate cancer treatment is problematic for most GBM. Research to develop more effective sexual recovery, tailored to the needs of GBM treated for prostate cancer, is needed. Six implications for clinicians treating GBM with prostate cancer are identified.

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References

  • Allensworth-Davies, D. (2012). Assessing localized prostate cancer post-treatment quality of life outcomes among gay men. Boston: Boston University School of Public Health. Retrieved from https://hdl.handle.net/2144/12263.

  • Allensworth-Davies, D., Talcott, J. A., Heeren, T., de Vries, B., Blank, T. O., & Clark, J. A. (2015). The health effects of masculine self-esteem following treatment for localized prostate cancer among gay men. LGBT Health,3(1), 49–56.

    Article  Google Scholar 

  • Beutel, M. E., Schumacher, J., Weidner, W., & Brahler, E. (2002). Sexual activity, sexual and partnership satisfaction in ageing men—results from a German representative community study. Andrologia,34, 22–28.

    Article  Google Scholar 

  • Blank, T. O. (2005). Gay men and prostate cancer: Invisible diversity. Journal of Clinical Oncology,23(12), 2593–2596.

    Article  Google Scholar 

  • Brimo, F., Montironi, R., Egevad, L., Erbersdobler, A., Lin, D. W., Nelson, J. B., … Epstein, J. I. (2013). Contemporary grading for prostate cancer: Implications for patient care. European Urology, 63(5), 892–901. https://doi.org/10.1016/j.eururo.2012.10.015.

    Article  Google Scholar 

  • Choi, E. P., Wong, C. K., Wan, E. Y., Tsu, J. H., Chin, W., Kung, K., & Yiu, M. (2016). The internal and external responsiveness of Functional Assessment of Cancer Therapy-Prostate (FACT-P) and Short Form-12 Health Survey version 2 (SF-12 v2) in patients with prostate cancer. Quality of Life Research,25(9), 2379–2393.

    Article  Google Scholar 

  • Damon, W., & Rosser, B. R. S. (2005). Anodyspareunia in men who have sex with men: Prevalence, predictors, consequences and the development of DSM diagnostic criteria. Journal of Sex and Marital Therapy,31, 129–141.

    Article  Google Scholar 

  • DeWitt, J., Capistrant, B. D., Kohli, N., Rosser, B. R. S., Mitteldorf, D., Merengwa, E., & West, W. (2018). Addressing participant validity in small Internet health survey samples: The Restore prostate cancer case study. JMIR Research Protocols,7(4), e96.

    Article  Google Scholar 

  • Dowsett, G. W. (2018). “Losing my Chestnut”: One gay man’s wrangle with prosate cancer—ten years on. In J. M. Ussher, J. Perz, & B. R. S. Rosser (Eds.), Gay & bisexual men living with prostate cancer: From diagnosis to recovery (pp. 258–270). New York, NY: Harrington Park Press.

    Chapter  Google Scholar 

  • Dowsett, G. W., Lyons, A., Duncan, D., & Wassersug, R. J. (2014). Flexibility in men’s sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sexual Medicine,2(3), 115–120. https://doi.org/10.1002/sm2.32.

    Article  Google Scholar 

  • Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health,103(10), 1802–1809.

    Article  Google Scholar 

  • Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R. D., Bowling, J., … Reece, M. (2014). From bias to bisexual health disparities: Attitudes toward bisexual men and women in the United States. LGBT Health,1(4), 309–318.

    Article  Google Scholar 

  • Gebert, S. (2014). Are penile prostheses a viable option to recommend for gay men? International Journal of Urological Nursing,8(3), 111–113.

    Article  Google Scholar 

  • Goldstone, S. E. (2005). The ups and downs of gay sex after prostate cancer treatment. In G. Perlman & J. Drescher (Eds.), A gay man’s guide to prostate cancer (pp. 43–55). Binghampton, NY: The Haworth Medical Press.

    Google Scholar 

  • Grey, J. A., Konstan, J., Iantaffi, A., Wilkerson, J. M., Galos, D., & Rosser, B. R. S. (2015). An updated protocol to detect invalid entries in an online survey of men who have sex with men (MSM): How do valid and invalid submissions compare? AIDS and Behavior,19(10), 1928–1937.

    Article  Google Scholar 

  • Harris, J. (2005). Living with prostate cancer: One gay man’s experience. Journal of Gay and Lesbian Psychotherapy,9(1–2), 109–117.

    Article  Google Scholar 

  • Hart, S., Coon, D., Kowalkowski, M., & Latini, D. (2011a). Gay men with prostate cancer report significantly worse HRQOL than heterosexual men. Paper presented at the Society for the Scientific Study of Sexuality, Houston, TX.

  • Hart, S., Coon, D., Kowalkowski, M., & Latini, D. (2011b). Gay men with prostate cancer report significantly worse HRQOL than heterosexual men. Journal of Urology,185(4), E68–E69. https://doi.org/10.1016/j.juro.2011.02.231.

    Article  Google Scholar 

  • Hart, T. L., Coon, D. W., Kowalkowski, M. A., Zhang, K., Hersom, J. I., Goltz, H. H., … Latini, D. M. (2014). Changes in sexual roles and quality of life for gay men after prostate cancer: Challenges for sexual health providers. Journal of Sexual Medicine,11(9), 2308–2317.

    Article  Google Scholar 

  • Hoyt, M. A., Frost, D. M., Cohn, E., Millar, B. M., Diefenbach, M. A., & Revenson, T. A. (2017). Gay men’s experiences with prostate cancer: Implications for future research. Journal of Health Psychology. https://doi.org/10.1177/1359105317711491.

    Article  Google Scholar 

  • Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: Institute of Medicine.

    Google Scholar 

  • Latini, D. M., Hart, S. L., Coon, D. W., & Knight, S. J. (2009). Sexual rehabilitation after localized prostate cancer: Current interventions and future directions. Cancer,15(1), 34–40. https://doi.org/10.1097/PPO.0b013e31819765ef.

    Article  Google Scholar 

  • Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States. Journal of the American Medical Association,281(6), 537. https://doi.org/10.1001/jama.281.6.537.

    Article  Google Scholar 

  • Lee, T. K., Breau, R. H., & Eapen, L. (2013). Pilot study on quality of life and sexual function in men-who-have-sex-with-men treated for prostate cancer. Journal of Sexual Medicine,10(8), 2094–2100.

    Article  Google Scholar 

  • Litwin, M. S., Gore, J. L., Kwan, L., Brandeis, J. M., Lee, S. P., Withers, H. R., & Reiter, R. E. (2007). Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer. Cancer,109(11), 2239–2247.

    Article  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin,129(5), 674–697.

    Article  Google Scholar 

  • Mitteldorf, D. (2005). Psychotherapy with gay prostate cancer patients. Journal of Gay and Lesbian Psychotherapy,9(1–2), 56–67.

    Google Scholar 

  • Motofei, I. G., Rowland, D. L., Popa, F., Kreienkamp, D., & Paunica, S. (2010). Preliminary study with bicalutamide in heterosexual and homosexual patients with prostate cancer. British Journal of Urology,108, 110–115.

    Article  Google Scholar 

  • Penson, D. F., Feng, Z., Kuniyuki, A., McClerran, D., Albertsen, P. C., Deapen, D., … Potosky, A. L. (2003). General quality of life 2 years following treatment for prostate cancer: what influences outcomes? Results from the prostate cancer outcomes study. Journal of Clinical Oncology,21(6), 1147–1154.

    Article  Google Scholar 

  • Rosen, R. (2003). Looking beyond erectile dysfunction: The need for multi-dimensional assessment of sexual dysfunction. European Urology Supplements,2(10), 9–12. https://doi.org/10.1016/j.eursup.2003.11.003.

    Article  Google Scholar 

  • Ross, M. W., Rosser, B. R. S., Coleman, E., & Mazin, R. (2006). Misrepresentation on the Internet and in real life about sex and HIV: A study of Latino men who have sex with men. Culture, Health and Sexuality,8(2), 133–144. https://doi.org/10.1080/13691050500485604.

    Article  Google Scholar 

  • Rosser, B. R. S., Capistrant, B. D., Torres, B., Konety, B. R., Merengwa, E., Mitteldorf, D., & West, W. (2016a). The effects of radical prostatectomy on gay and bisexual men’s mental health, sexual identity, and relationships: Qualitative results from the Restore study. Journal of Sex and Relationship Therapy,31(4), 446–461. https://doi.org/10.1080/14681994.2016.1228871.

    Article  Google Scholar 

  • Rosser, B. R. S., Capistrant, B. D., Torres, B., Konety, B. R., Merengwa, E., Mitteldorf, D., & West, W. (2016b). The effects of radical prostatectomy on gay and bisexual men’s sexual functioning and behavior: Qualitative results from the Restore study. Journal of Sex and Relationship Therapy,31(4), 432–445.

    Article  Google Scholar 

  • Rosser, B. R. S., Gurak, L., Horvath, K. J., Oakes, J. M., Konstan, J., & Danilenko, G. (2009a). The challenges of ensuring participant consent in Internet-based sex studies: A case study of the Men’s INTernet Sex (MINTS-I and II) studies. Journal of Computer-Mediated Communication.,14, 606–626.

    Google Scholar 

  • Rosser, B. R. S., Konety, B. R., Kohli, N., Lesher, L., Capistrant, B. D., Merengwa, E., … West, W. (2018a). What gay and bisexual prostate cancer patients want in a sexual rehabilitation program for prostate cancer: Results of the Restore needs assessment. Urology Practice,5(3), 192–197.

    Article  Google Scholar 

  • Rosser, B. R. S., Konety, B. R., Mitteldorf, D., Kohli, N., Lesher, L., West, W., … Merengwa, E. (2018b). What gay and bisexual men treated for prostate cancer are offered and attempt as sexual rehabilitation for prostate cancer: Quantitative results from the Restore study with implications for clinicians. Urology Practice,5(3), 187–191.

    Article  Google Scholar 

  • Rosser, B. R. S., Merengwa, E., Capistrant, B. D., Iantaffi, A., Kilian, G., Kohli, N., … West, W. (2016c). Prostate cancer in gay, bisexual and other men who have sex with men: A review. LGBT Health,3(1), 32–41. https://doi.org/10.1089/lgbt.2015.0092.

    Article  Google Scholar 

  • Rosser, B. R. S., Metz, M., Bockting, W. O., & Buroker, T. (1997). Sexual difficulties, concerns and satisfaction in homosexually active men: An empirical study with implications for HIV prevention. Journal of Sex and Marital Therapy,23(1), 60–72.

    Google Scholar 

  • Rosser, B. R. S., Miner, M. H., Bockting, W. O., Ross, M. W., Konstan, J., Gurak, L., … Coleman, E. (2009b). HIV risk and the internet: Results of the men’s INTernet study (MINTS). AIDS and Behavior,13(4), 746–756.

    Article  Google Scholar 

  • Rosser, B. R. S., Oakes, J. M., Horvath, K. J., Konstan, J. A., Danilenko, G. P., & Peterson, J. L. (2009c). HIV sexual risk behavior by men who use the internet to seek sex with men: Results of the Men’s INTernet sex study-II (MINTS-II). AIDS and Behavior,13(3), 488–498.

    Article  Google Scholar 

  • Rosser, B. R. S., Short, B. J., Thurmes, P. J., & Coleman, E. (1998). Anodyspareunia, the unacknowledged sexual dysfunction: A validation study of painful anal intercourse in homosexual men. Journal of Sex and Marital Therapy,24(4), 281–292.

    Article  Google Scholar 

  • Santillo, V. M., & Lowe, F. C. (2005). Prostate cancer and the gay male. Journal of Gay and Lesbian Psychotherapy,9(1–2), 9–27.

    Article  Google Scholar 

  • Smith, J. A., Filiault, S. M., Drummond, M. J. N., & Knappman, R. J. (2007). The psychosocial impact of prostate cancer on patients and their partners. Medical Journal of Australia,186(3), 159–160.

    Article  Google Scholar 

  • Thomas, C., Wootten, A., Robinson, P., Law, P., & McKenzie, D. (2018). The impact of sexual orientation on body image, self-esteem, urinary and sexual functions in the experience of prostate cancer. European Journal of Cancer Care. https://doi.org/10.1111/ecc.12827.

    Article  Google Scholar 

  • Turner, C. F., Ku, L., Rogers, S. M., Lindberg, L. D., Pleck, J. H., & Sonenstein, F. L. (1998). Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology. Science,280, 867–873.

    Article  Google Scholar 

  • Ussher, J. M., Perz, J., Kellett, A., Chambers, S., Latini, D., Davis, I. D., … Williams, S. (2016). Health-related quality of life, psychological distress, and sexual changes following prostate cancer: A comparison of gay and bisexual men with heterosexual men. Journal of Sexual Medicine,13(3), 425–434. https://doi.org/10.1016/j.jsxm.2015.12.026.

    Article  Google Scholar 

  • Ware, J. E., Kosinski, M., & Keller, S. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care,34(3), 220–233.

    Article  Google Scholar 

  • Wassersug, R. J., Lyons, A., Duncan, D., Dowsett, G. W., & Pitts, M. (2013). Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer. Urology,82, 565–571.

    Article  Google Scholar 

  • Wassersug, R. J., Westle, A., & Dowsett, G. W. (2016). Men’s sexual and relational adaptations to erectile dysfunction after prostate cancer treatment. International Journal of Sexual Health,12, 1–11. https://doi.org/10.1080/19317611.2016.1204403.

    Article  Google Scholar 

  • Wei, J. T., Dunn, R. L., Litwin, M. S., Sandler, H. M., & Sanda, M. G. (2000). Development and validation of the Expanded Prostate Cancer Index Composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology,56(6), 809–905.

    Article  Google Scholar 

  • West, W., Rosser, B. R. S., Capistrant, B. D., Torres, B., Konety, B. R., Mitteldorf, D., … Talley, K. M. (2018). The effects of radiation therapy for prostate cancer on gay and bisexual men’s mental health, sexual functioning and behavior, sexual identity and relationships: Qualitative results from the Restore study. In J. Ussher, J. Perz, & B. R. S. Rosser (Eds.), Gay and bisexual men living with prostate cancer: From diagnosis to recovery (pp. 216–229). New York, NY: Harrington Park Press.

    Google Scholar 

  • Wittmann, D., He, C., Coelho, M., Hollenbeck, B., Montie, J. E., & Wood, D. P. (2011). Patient preoperative expectations of urinary, bowel, hormonal and sexual functioning do not match actual outcomes 1 year after radical prostatectomy. Journal of Urology,186(2), 494–499.

    Article  Google Scholar 

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Acknowledgements

This study was conducted with funding from the National Cancer Institute (NCI) (Grant award: 1 R21 CA182041).

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Authors and Affiliations

  1. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., #300, Minneapolis, MN, 55454, USA

    B. R. Simon Rosser, Elizabeth J. Polter, Lindsey Lesher, James Dewitt & Gunna Kilian

  2. Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA

    Nidhi Kohli

  3. School of Social Work, Smith College, Northampton, MA, USA

    Beatrix D. Capistrant

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

    Badrinath R. Konety

  5. Malecare Cancer Support, New York, NY, USA

    Darryl Mitteldorf

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

    William West

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  1. B. R. Simon Rosser
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Rosser, B.R.S., Kohli, N., Polter, E.J. et al. The Sexual Functioning of Gay and Bisexual Men Following Prostate Cancer Treatment: Results from the Restore Study. Arch Sex Behav 49, 1589–1600 (2020). https://doi.org/10.1007/s10508-018-1360-y

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