The majority of gay and bisexual men with prostate cancer did not have their sexual identity adequately considered throughout all stages of treatment and diagnosis, according to a new survey from The Focal Therapy Clinic.
With prostate cancer incident rates set to increase by 14% over over the next decade, doctor’s being properly equipped to manage patients across all walks of life grows only more vital.
Key findings:
- Two in three gay and bisexual men felt misunderstood by doctors when discussing the side effects of their prostate cancer treatment
- The most common side effect among this group was a change in the ability to engage in anal intercourse
- Only 1% of gay or bisexual men avoided every side effect that impaired their sexual function
- A quarter of patients ended up choosing a treatment plan that wasn’t right for them
- Alan Doherty, Consultant Urologist at The Focal Therapy Clinic, weighs in on the findings
Table 1: Where doctors fell short in supporting gay and bisexual men with prostate cancer
The Focal Therapy Clinic asked patients how well healthcare professionals accounted for their sexual identity at each stage of their care.
| Stage | % didn’t feel doctors were sensitive of their sexuality |
| When being diagnosed | 71% |
| When discussing side effects of treatment | 63% |
| When discussing recovery and ongoing care | 53% |
| When discussing treatment options | 53% |
Diagnosis, arguably the point where sensitivity matters most, is where doctors performed worst: over seven in ten patients said healthcare professionals weren’t sensitive and understanding of their sexual identity at this stage.
This gap has, if anything, widened over time: 73% of those diagnosed 1-5 years ago reported a lack of sexual sensitivity at diagnosis, versus 67% of those diagnosed 6-10 years ago.
Doctors also fall short when it comes to discussing treatment side effects. Since so many of these side effects affect sexual function, tailoring information and materials to a patient’s context should be standard practice, yet it’s an area where gay and bisexual men are consistently being let down.
63% of gay and bisexual men said doctors didn’t understand their sexual identity and needs when discussing potential side effects, a gap with a real, measurable impact.
Table 2: The sexual side effects gay and bisexual men experience most after treatment
| Side effect | % |
| Changes in ability to engage in anal intercourse (e.g. comfort, pain, function) | 39% |
| Erectile dysfunction, that affected sexual activity | 37% |
| Altered orgasmic function or sexual pleasure | 35% |
| Difficulty maintaining intimacy or sexual communication | 34% |
| Reduced sexual confidence or libido | 31% |
| None of the above | 1% |
Virtually every gay or bisexual man surveyed experienced at least one side effect that got in the way of his sex life, with just 1% escaping unaffected.
Each side effect was reported by 31-39% of respondents, with changes in the ability to engage in anal intercourse the most common (37%), narrowly ahead of erectile dysfunction (37%). A quarter (25%) said they weren’t adequately prepared for these effects (see table 3).
Properly acknowledging a patient’s sexual context could change these outcomes considerably. More than half (53%) said doctors failed to understand their sexual identity when discussing treatment options, despite treatments such as HIFU preserving sexual function in over 90% of patients, a clear sign that gay and bisexual men aren’t being given the full picture of their options.
Table 3: The wider impact of treatment beyond physical side effects
Beyond the direct medical side effects, The Focal Therapy Clinic also looked at the broader challenges gay and bisexual patients face during treatment and recovery.
| Challenge | % |
| Faced issues in my relationship due to poor planning | 31% |
| Contributed to depression, anxiety, or other mental health problems | 29% |
| Experienced sexual side effects I wasn’t adequately warned about | 25% |
| I chose a treatment plan that wasn’t right for me | 25% |
| I had to find information elsewhere | 25% |
| I didn’t feel comfortable raising concerns with my doctor | 21% |
| I felt embarrassed, isolated, or otherwise unable to discuss my experiences with my partner, friends, or family | 19% |
Every single man surveyed reported at least one of these knock-on consequences. The most common, at 31%, was relationship strain caused by poor planning, an issue that hit married men (42%) far harder than those in a relationship but unmarried (15%).
A similar proportion, 29%, said treatment and recovery had contributed to depression, anxiety or another mental health condition, problems that may well have been avoidable with better understanding from doctors.
Alan Doherty, Consultant Urologist at The Focal Therapy Clinic, says many clinicians simply don’t have the time – or, in some cases, the experience – to fully counsel men on the benefits and risks of the various prostate cancer treatment options. “Initial discussions understandably tend to focus on cure, but quality of life is also a critical consideration,” he says.
Patients differ considerably in how they balance quality of life against longevity, he notes, and it isn’t yet known how far the priorities of gay men differ from those of heterosexual men who also place a high value on sexual function. “While sexual function isn’t equally important to all men, it shouldn’t be assumed unimportant just because a patient doesn’t raise the issue,” Doherty says.
As most prostate cancers do not prove fatal within 10 years of diagnosis, Doherty says men need to think carefully about what matters most to them and what trade-offs they’re willing to accept – shaped by factors including the type and extent of the cancer, the treatment chosen, baseline sexual function, and how consistent and reproducible the outcomes are likely to be. “Given the complexity of these decisions,” he says, “it’s perhaps unsurprising that some men experience treatment regret.”
