Pilot Study on Quality of Life and Sexual Function in Men Who Have Sex with Men Treated for Prostate Cancer

Abstract

Data on post-treatment quality of life experienced by homosexual population with prostate cancer is limited. Homosexual male sexuality is potentially tied to both erectile and rectal functions, which may not be reflected by general quality of life assessment tools designed for the heterosexual population. The purpose of this study was to investigate treatment side effects on quality of life and sexual function in homosexual prostate cancer patients. Homosexual prostate cancer patients treated with radical prostatectomy (RP) and XRT (external beam radiotherapy or brachytherapy) residing in Ottawa were recruited. Only patients with initial PSA, T stage, Gleason score, and detailed treatment record were included. Each participant received a prepaid envelope containing Expanded Prostate Cancer Index Composite (EPIC), Male Sexual Health Questionnaire (MSHQ), and a separate questionnaire focused on anal intercourse and receptive role before and after PCA treatment. Returned responses were tabulated based on treatment modality. Seven participants treated with bilateral nerve sparing RP (initial age 49-63) and eight participants treated with XRT (initial age 58-66) have been recruited. None of the participants in the RP group has received androgen deprivation therapy (ADT) while two in XRT group were treated with ADT. Based on EPIC, Urinary Irritation was worse in the radiation group (p = 0.009), with a trend for worse Bowel Function and Bowel Summary in the radiation group. Sexual Summary scores are not statistically different between the two groups. MSHQ reviewed worse Ejaculation Scale in the surgical group (p = 0.01) with Satisfaction Scale not statistically different. Within the surgical group, one of four and zero of three participants who have previously insertive and receptive anal intercourse role respectively maintained the same role. One reported no change in sexual practice while two reported increased activity in mutual stimulation and four have reported increase in self stimulation. Within the radiation group, five of five participants who performed insertive role in anal intercourse prior to treatment could perform the same role. Two of the two participants continued to have receptive anal intercourse. Four reported no change in sexual practice, two reported more mutual stimulation and two reported more self stimulation as sexual practice. This study utilizes EPIC and MSHQ, which are validated quality of life assessment tools designed for the heterosexual population. This is also the only existing series on homosexual prostate cancer patients with documented diagnosis and treatment. Although most of the subscales are not statistically significant, it seems that RP may have better urinary and bowel side effect profile than XRT, while ejaculation scale is worse with surgery. Sexual function is similar between the two groups based on these two questionnaires. However, experienced sexual function related to anal intercourse seem to favor XRT. This is in the setting of younger age in the RP group with some participants in the XRT group having history of ADT. Future larger studies in homosexual prostate cancer patients are warranted to verify these data and to elucidate reasons for change in sexual behavior.