Prostate cancer treatment outcomes among gay men

A poster presentation given on Sunday at the AUA annual meeting (and an associated media briefing) strongly suggested that gay males diagnosed with prostate cancer tend to have less good clinical outcomes than straight males.

Research on the comparative impact of a diagnosis and treatment for prostate cancer on gay as compared to straight men is very limited, so the new study by Hart et al. (as presented by Latini; see AUA abstract no. 163) is a useful addition to the available literature, but it is still only a very small study based on a “convenience sample” of just 92 men who, according to Dr. Latini (as quoted in a Medscape report), were “extremely hard to find.”

These 92 American and Canadian men were recruited from clinics, support groups, and through a variety of other tactics. “We had to fight tooth and nail for 2 years to find these 92 guys,” Dr. Latini has stated, adding that ads on the Internet, as well as flyers in cafés, bars, and restaurants in gay communities, were used for outreach.

The participants completed an Internet-based survey based on a set of standard quality of life questionnaires, including the Expanded Prostate Cancer Index (EPIC) and the Male Sexual Health Questionnaire Short-Form. Their responses were compared to a set of “norms,” based on data from a separately and previously evaluated set of men who had undergone comparable surveys but who not been asked about their sexual identity

The data presented by Hart et al. were as follows:

  • Average age of study participants was 57.8 ± 0.97 years.
  • Most participants were white (91.3 percent) or African-American (5.4 percent).
  • More than half were in partnership relationships (63.1 percent), and had college degrees (69.5 percent).
  • Diagnostic and treatment data for the 92 participants appear to be relatively unremarkable.
    • Average (mean) PSA at diagnosis was 8.75 ± 1.11.
    • Clinical stages at diagnosis were  T1-T2a (71 percent), T2b-T2c (11 percent), and T3-T4 (18 percent).
    • Average (mean) Gleason score at biopsy was 6.72 ± 1.14.
    • First-line treatments included surgery (55.4 percent), external beam radiation therapy (27.2 percent), and brachytherapy (7.6 percent).
    • 25 percent of participants reported adjuvant or neoadjuvant hormone therapy.
  • Study participants reported worse function scores and more severe bother scores than the comparative set of “norms.”
  • Specifically, the gay males reported
    • Worse EPIC-based urinary, bowel, and hormonal symptom scales
    • Worse EPIC-based sexual functioning and ejaculatory functioning scores
    • Worse mental health functioning
    • Greater fear of cancer recurrence

Hart et al. conclude that “Gay men may be particularly vulnerable to decrements in [health-related quality of life] after prostate cancer treatment.” And this is an entirely reasonable conclusion based on the data collected.

The “New” Prostate Cancer InfoLink does worry, however, that the difficulty admitted by the authors in identifying and finding men willing to participate in this survey may have impacted the data collected. It is not clear from the available data why gay men should be so unwilling to discuss a very common and normal male disorder. It is also not clear what percentage of the participants may have been HIV positive, which might also have impact on their prostate cancer and their attitudes to having cancer at all.

Being gay in North American society still comes with many challenges over many years. The degree to which the outcomes effects reported in this study are in any way related to the biology of being gay (as opposed to the psychological and sociological impact) are not evident at this time. Nor can it necessarily be assumed that the participants in this study are entirely representative of gay men with prostate cancer if so many in the gay community are simply unwilling to participate in health surveys of this type.

2 Responses

  1. I am gay, HIV+, and have had prostate surgery. I have healed well post surgery. No major complications as far as incontinence either. Three months of annoyance while waiting for my bladder to get up to speed. I am now free of bladder leakage. My emotional health is good overall. I have no clue as to what is going on with these 92 men; however, this study needs to be redone. It should not be that complicated to find gay men.

  2. Thank you so much for this personal insight. We are pleased to see our own concern about this study reflected in your comments.

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