Nick Mulcahy

May 15, 2011

May 15, 2011 (Washington, DC)Gay men treated for prostate cancer reported lower health-related quality-of-life scores than generalized populations of men, according to a first-of-its kind study presented here at the American Urological Association (AUA) 2011 Annual Scientific Meeting.

In an Internet-based survey, 92 gay men from the United States and Canada reported worse functioning — including for mental health — and worse physical symptoms "across the board," said senior author David Latini, PhD, from Baylor College of Medicine in Houston, Texas. They also had a significantly greater fear of cancer recurrence, said Dr. Latini during a press briefing.

These differences were large enough to be "clinically meaningful," said Dr. Latini.

"The negative impact on gay men is more profound than that of straight men in terms of health-related quality of life," said Tomas L. Griebling, MD, MPH, from the University of Kansas in Kansas City. He is an AUA spokesperson and moderated the press briefing.

The study, which is the first to quantify the impact of prostate cancer in these men, used previously published normative data from general male populations as a comparator cohort.

Gay men comprise an estimated 3% to 5% of adult males in the United States, and the same proportion of gay men have prostate cancer as in the general population, said Dr. Latini. However, little is known about how prostate cancer and its treatment affect their quality of life, he added.

"These men haven't been studied. They've been included in other studies, but as a silent minority," said Dr. Griebling, adding that urological researchers do not ask about sexual orientation.

Literature on this topic is limited to a few published studies with small samples and only qualitative data, Dr. Latini told reporters at the press briefing.

Why do gay men fare worse with prostate cancer? "We really don't understand why it's been so difficult," said Dr. Latini. But there are some possible explanations, he said, including a lack of prostate cancer support groups for gay men.

Gay men might also experience adverse effects from prostate cancer treatment differently than straight men, Dr. Latini pointed out. For instance, anal intercourse requires a more robust erection than vaginal intercourse. Some degree of loss of erectile function might have more of an impact during gay sex, he suggested.

Shedding light on the big effect of prostate cancer on gay men will be a challenge, noted Dr. Latini.

"We had to fight tooth and nail for 2 years to find these 92 guys," he said, explaining that ads on the Internet, as well as flyers in cafes, bars, and restaurants in gay communities, were used for outreach.

"They are an extremely hard group to find," he said.

Details on the Convenience Sample

Dr. David Latini

The study was a "convenience sample," said Dr. Latini, and the researchers had not looked at predictors of outcome, such as age, ethnicity, and baseline disease characteristics. The average age of the survey participants was 57.8 years, and they were primarily white (91.3%) or African American (5.4%). Most were in a partnered relationship (63.1%) and had completed college (69.5%).

The majority of the men had early prostate cancer: 71% were clinical stage T1 to T2a; 11% were clinical stage T2b to T2c; and 18% were clinical stage T3 to T4 (18%).

At diagnosis, mean prostate-specific antigen level was 8.75 and mean Gleason score was 6.72.

The participants had all been treated and reported, as primary therapy, surgery (55.4%), external radiotherapy (27.2%), or brachytherapy (7.6%). In addition, 25% reported adjuvant or neoadjuvant hormone therapy.

The survey participants reported statistically significantly worse functioning and more severe "bother" scores than norms on the Expanded Prostate Cancer Index (EPIC) urinary, bowel, and hormonal symptom scales (P values ranging from <.015 to .0001).

The gay male respondents also reported significantly worse EPIC sexual functioning scores (P < .002) and ejaculatory functioning scores (P < .01) than norms, but not significantly worse sexual bother scores — which was the rare exception in which gay men fared better than their heterosexual counterparts.

Compared with norms, the gay men reported significantly worse mental health functioning (P < .0001) on the Short Form 36 Health Survey, but had similar physical health functioning.

Notably, gay men reported a significantly greater fear of cancer recurrence (< .0001) than men in other published research.

The authors have disclosed no relevant financial relationships.

American Urological Association (AUA) 2011 Annual Scientific Meeting: Abstract 163. Presented May 15, 2011.

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