How Gay Men Can Cope with Prostate Cancer

A urologic surgeon offers advice for early diagnosis and a potential cure.

Although the awareness of prostate cancer has increased in recent years, little to no literature addresses the needs of gay men with prostate cancer or their partners who want to offer support. This article is meant to help fill that void.

What are the odds?

Prostate cancer is blind to sexual orientation. About one in seven men will be diagnosed with prostate cancer during their lifetimes. It is the second-most-common cancer diagnosed and the second-most-common cause of cancer death in American males.

So, what can you do? The best course of action is to educate yourself so you can assume a proactive and participatory role in the treatment process.

The key to early diagnosis and a potential cure is a yearly digital rectal examination by a qualified examiner, a PSA (prostate-specific antigen) blood test, and an ultrasonic-guided prostate biopsy, if needed.

Treatment options

Prostate cancer treatment depends on a number of factors, including the patient’s physical condition and the type and stage of the cancer when diagnosed. In many cases, the recommended treatment is a robotic total nerve-sparing prostatectomy. This entails surgically removing the entire prostate gland through a coin-sized incision using the da Vinci robot, a computerized surgical device, to provide magnification and enhanced dexterity to the surgical hand.

Robotic surgery has many advantages over open surgery. It results in considerably less blood loss, the rare need for blood transfusions, an overnight hospital stay for the patient, less postoperative discomfort, no risk of a hernia at the surgical site, and the ability to preserve both potency and continence.

With the current controversy around prostate cancer screening and PSA testing, a trend appears to be developing away from aggressive surgical treatment for early-stage localized prostate cancer. Most urologists and radiation oncologists regard watchful waiting or active surveillance as an effective strategy for managing low-risk prostate cancer.

However, recommending active surveillance depends on the patient’s age, tumor size, tumor grade (level of aggressiveness), tumor stage (organ confinement), and PSA levels. Surgeons and radiation oncologists agree that this approach is safe and does not decrease the survival rate from early-stage prostate cancer.

 (Sex) Life after prostate cancer

When patients learn they have prostate cancer, they often lament, “You might as well cut off my penis!” In almost all cases, their fear of impotence is unwarranted. Because the prostate is a secondary sexual organ, your penis can perform perfectly well without it. Whereas the old surgical cure left about 60% of patients impotent (because surgery damaged the vital nerve bundles that make erection possible), today about 90% of our patients have full penis power after the recuperation period. The remaining 10% are commonly treated successfully for any erectile dysfunction (ED) with drugs such as Cialis and Viagra or injectables.

ED pills are almost universally helpful in such cases, and taking them is not a sign of weakness. However, men who have coronary artery disease and are taking medicines such as nitroglycerin should not take ED pills.

ED drugs can also be dangerous for men taking medication for HIV infections because these patients are much more sensitive to the effects of the oral medication. Therefore, for HIV patients, the smallest possible dose of the ED drugs should be used to achieve adequate performance levels.

Testosterone and prostate cancer don’t mix

Testosterone-replacement therapy (TRT) has become popular, but it has dangers. TRT drugs can diminish sperm count, thicken the blood, and accelerate a previously undiagnosed prostate cancer. Although TRT does not induce the development of prostate cancer, it can act like a fertilizer and cause rapid and potentially catastrophic growth of prostate cancer. Even with a tiny focus of cancerous cells in an otherwise benign prostate, TRT can encourage these cells to grow explosively.

Dealing with depression

Anxiety and depression are common responses to a cancer diagnosis. But if you maintain faith in yourself, develop a healthy method for dealing with your emotions, and learn how to extract the positive elements from every experience, you can climb out of depression and convert your worries into effective action.

Using your sexual organs for the purpose that nature intended not only is one of life’s great pleasures but also provides excellent health benefits. Sex is good for your mood and psychological well-being. It also is excellent for overall fitness: It benefits circulation, stimulates the nervous system and the prostate gland, and invigorates the whole body.

If you are the partner of a man dealing with prostate cancer, try to be sensitive to the cues your partner gives you and communicate in an open, honest, considerate way. Move slowly and explore the sensuality of your experience, paying close attention to your lover’s body language. If you pay attention to the cues of a partner who is feeling down and use every weapon in your sexual arsenal, you can make a difficult situation a delight.

Dudley S. Danoff, MD

Communication is key

Communication, awareness, and consideration are the best triad to navigate the trials and tribulations of a prostate cancer diagnosis. Two mature people with a strong commitment have the greatest potential for weathering the storm. This does not mean that problems will not arise. You must be aware that every conflict affects your sexuality. You also have to be aware that the most effective response to a conflict is to work things out in a healthy way.

Many patients live long and productive lives with prostate cancer. A physician who does a thorough examination can make a timely diagnosis nearly 100 percent of the time. If the diagnosis is made early enough to allow the maximum effective treatment, life after prostate cancer surgery or other treatment can be rich and rewarding, allowing a man to be continent, sexually active, and vigorous in all areas of his life.

Dudley Seth Danoff, M.D., FACS, is president and founder of the Cedars-Sinai Tower Urology Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and the author of “The Ultimate Guide to Male Sexual Health.”