By Arlen Leight , Ph.D.
A diagnosis of prostate cancer is a frightening prospect for both men and their partners. Unfortunately, most physicians treating for prostate cancer never inform their gay patients that the implications will impact gay male sex differently than for straight male sex.
The result can be uninformed, under-informed, or misinformed treatment selection. Prostate cancer is the second leading cause of cancer deaths in men. One out of every six men will develop prostate cancer, as compared to one out of every eight women who will develop breast cancer.
If you live to age 80, your chances are greater than 50 percent that you will develop prostate cancer. For a gay male couple, there is a 28 percent chance that one partner or the other will be diagnosed with prostate cancer during their lives together. If you have a father or brother who has had prostate cancer or if you are African American, your risk doubles. Diagnosis is always confirmed by biopsy, but PSA blood tests and digital rectal examinations are used for initial screening.
These are generally recommended for men over 50 (or over 40 if in a high risk group). If you take Propecia for hair loss or Proscar for prostate enlargement, your PSA may be falsely low. You want to double the number for accuracy. And gay-receptive partners should wait three days after anal penetration, as prostate massage can elevate the PSA. Your physician should perform a digital exam AFTER he or she takes your blood.
The most commonly prescribed treatment after a diagnosis of prostate cancer is prostatectomy, or removal of the prostate. This is major surgery with the potential for major residual, life altering implications. While considered the “gold standard” for curing prostate cancer, five to 10 percent of men remain incontinent, and for men under 60, 25 to 30 percent remain impotent. For men over 70, 70 to 80 percent remain impotent.
And sexual function tends to improve with time. Erectile rigidity post-treatment may be sufficient for vaginal penetration, but often isn’t sufficient for anal penetration. There are erectile treatments available that can help or even restore function, so consult your urologist for assistance in this regard. The other major change in sexual function is that ejaculation will now be retrograde (so the ejaculate will back up the urethra rather than forge out the penis). This can be disturbing, but men are still able to ejaculate even if they cannot attain a significant erection.
The other curative option that is generally recommended is radiation therapy. With radiation, less than two percent remain incontinent. Recurrence of cancer is three to 40 percent higher than with prostatectomy (depending upon the stage of the cancer). There is a risk of frequent urination, burning, and chronic bowel complications. Rectal bleeding is a problem in around five percent of brachytherapy (radiation) patients. Because radiation has long term effects, sexual function may not be impaired at first, but may decrease over time.
The rates of impotence are approximately the same as for surgery. There may likewise be penile shrinkage, and a decreased amount of ejaculate. Radiation can be problematic for men who enjoy being penetrated. Anal bleeding, diarrhea, and tightening and/ or spasm of the sphincter may make anal penetration uncomfortable or impossible. Psychologically, an overall sense of helplessness, anger, loss/grief, depression, and anxiety are very common.
Communication with partners about fears, embarrassment, and frustrations are critical. Patience is vital for the man with prostate cancer—and his partner—as recovery is often slow and uncertain.