Prostate cancer is the second most common cause of cancer-related death in men in the USA, but the effect of prostate cancer diagnosis and treatment on men in a sexual minority group, including men who have sex with men and transgender women, is poorly understood. Efforts to study this population are complicated, as cancer registries do not routinely collect information on sexual orientation. As a result, epidemiological data regarding this population have come from small studies that have included disparate rates of prostate cancer screening, diagnosis and treatment. Qualitative studies indicate that prostate cancer is experienced differently by sexual minorities, with distinct health-care needs that arise owing to differences in sexual practices, social support systems and relationships with the medical community. Notably, sexual minorities have been reported to experience poorer health-related quality of life outcomes than heterosexual men, and tend to have less robust social support systems, experience increased psychological distress caused by sexual dysfunction (areas of which are unmeasured after treatment), experience isolation within the health-care system and express increased levels of dissatisfaction with treatment. The incidence of prostate cancer actually seems to be decreased in men from sexual minorities living with HIV, despite there being no differences in screening and treatment, with poor cancer-specific mortality. Although the literature on patients with prostate cancer in men from sexual minority groups has historically been sparse, peer-reviewed research in this area has grown considerably during the past decade and has become an important field of study.
Men from sexual minorities who are diagnosed with prostate cancer can have different experiences from heterosexual men and rely on different support networks to navigate their illness.
No clear evidence exists to suggest that screening practices and rates of diagnosis of prostate cancer vary in men from sexual minorities compared with heterosexual men.
Men from sexual minorities with prostate cancer have poorer health-related quality of life and show a small but significant increase in psychological distress associated with the sexual adverse effects of treatment than their heterosexual counterparts.
Health-care providers are often underprepared to address the unique needs of these men; moreover, few validated questionnaires are able to assess sexual function in men who participate in both penetrative and receptive anal intercourse.
The intersecting diagnoses of prostate cancer and HIV in men from sexual minorities can lead to further disparities in care, with reduced cancer-specific survival in HIV-positive men.
Transgender women should be screened for prostate cancer as they seem to remain at risk of the disease after transition; a serum PSA concentration of 1 ng/ml should be used as the upper limit of normal in these patients, as gender-affirming hormone therapy can artificially lower PSA levels.
This is a preview of subscription content
Subscribe to Nature+
Get immediate online access to the entire Nature family of 50+ journals
Subscribe to Journal
Get full journal access for 1 year
only $4.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
National Cancer Institute. Cancer stat facts: prostate cancer. NIH https://seer.cancer.gov/statfacts/html/prost.html (2017).
Miller, K. D. et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J. Clin. 66, 271–289 (2016).
Siegel, R. L., Miller, K. D. & Jemal, A. Cancer statistics, 2019. CA Cancer J. Clin. 69, 7–34 (2019).
Rosser, B. R. M. et al. Prostate cancer in gay, bisexual, and other men who have sex with men: a review. LGBT Health 3, 32–41 (2016).
Couper, J. The effects of prostate cancer on intimate relationships. J. Mens Health Gend. 4, 226–232 (2007).
Rosser, B. R. S. et al. in Gay and Bisexual Men Living with Prostate Cancer: from Diagnosis to Recovery (eds Perz, J., Ussher, J. M. & Rosser, B. R. S.) 12–37 (Harrington Park Press, LLC, 2018).
Grey, J. A. et al. Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Survey. JMIR Public Health Surveill. 2, e14 (2016).
Ussher, J. M., Perz, J. & Rosser, B. R. S. in Gay and Bisexual Men Living with Prostate Cancer: from Diagnosis to Recovery (eds Perz, J., Ussher, J. M. & Rosser, B. R. S.) 2–8 (Harrington Park Press, LLC, 2018).
Blank, T. O. Gay men and prostate cancer: invisible diversity. J. Clin. Oncol. 23, 2593–2596 (2005).
Matheson, L. et al. A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men. Eur. J. Cancer Care (Engl.) 26, e12676 (2017).
Kelly, D., Sakellariou, D., Fry, S. & Vougioukalou, S. Heteronormativity and prostate cancer: a discursive paper. J. Clin. Nurs. 27, 461–467 (2018).
Arthur, E. K. & Kamen, C. S. Hidden patients, hidden partners: prostate cancer care for gay and bisexual men. Oncol. Nurs. Forum 45, 435–438 (2018).
Mitteldorf, D. Psychotherapy with gay prostate cancer patients. J. Gay Lesbian Psychother. 9, 57–67 (2005).
Boehmer, U., Miao, X. & Ozonoff, A. Cancer survivorship and sexual orientation. Cancer 117, 3796–3804 (2011).
Office of Disease Prevention and Health Promotion. Lesbian, gay, bisexual and transgender health. HealthyPeople https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health (2017).
United States Department of Justice. Obergefell et al. v. Hodges, director, Ohio Department of Health, et al. U.S. Department of Justice https://www.justice.gov/sites/default/files/crt/legacy/2015/06/26/obergefellhodgesopinion.pdf (2015).
Herek, G. M. Legal recognition of same-sex relationships in the United States: a social science perspective. Am. Psychol. 61, 607–621 (2006).
Pew Research Center. 5. Homosexuality, gender and religion. Pew Research Center http://www.people-press.org/2017/10/05/5-homosexuality-gender-and-religion/#changing-views-on-acceptance-of-homosexuality (2017).
Gajanan, M. Calls to crisis support lines up after Donald trump's victory. Time Magazine http://time.com/4565274/crisis-support-line-donald-trump-election/ (2016).
Pear, R., P. J. Trump gives health workers new religious liberty protections New York Times A14 (19 Jan 2018).
Nguyen, K. H., Trivedi, A. N. & Shireman, T. I. Lesbian, gay, and bisexual adults report continued problems affording care despite coverage gains. Health Aff. (Millwood) 37, 1306–1312 (2018).
United States Preventive Services Task Force. Final recommendation statement: prostate cancer: screening. U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening (2013).
Fleshner, K., Carlsson, S. V. & Roobol, M. J. The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat. Rev. Urol. 14, 26–37 (2017).
United States Preventive Services Task Force. Final recommendation statement: prostate cancer: screening. U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening1 (2018).
Quinn, G. P. et al. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J. Clin. 65, 384–400 (2015).
Fredriksen-Goldsen, K. I., Kim, H. J., Barkan, S. E., Muraco, A. & Hoy-Ellis, C. P. Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am. J. Public Health 103, 1802–1809 (2013).
Heslin, K. C., Gore, J. L., King, W. D. & Fox, S. A. Sexual orientation and testing for prostate and colorectal cancers among men in California. Med. Care 46, 1240–1248 (2008).
Conron, K. J., Mimiaga, M. J. & Landers, S. J. A population-based study of sexual orientation identity and gender differences in adult health. Am. J. Public Health 100, 1953–1960 (2010).
Kamen, C. et al. Disparities in health risk behavior and psychological distress among gay versus heterosexual male cancer survivors. LGBT Health 1, 86–92 (2014).
Mandel, J. S. & Schuman, L. M. Sexual factors and prostatic cancer: results from a case-control study. J. Gerontol. 42, 259–264 (1987).
Rosenblatt, K. A., Wicklund, K. G. & Stanford, J. L. Sexual factors and the risk of prostate cancer. Am. J. Epidemiol. 153, 1152–1158 (2001).
Spence, A. R., Rousseau, M. C. & Parent, M. E. Sexual partners, sexually transmitted infections, and prostate cancer risk. Cancer Epidemiol. 38, 700–707 (2014).
Hart, T. L. et al. Changes in sexual roles and quality of life for gay men after prostate cancer: challenges for sexual health providers. J. Sex. Med. 11, 2308–2317 (2014).
Ussher, J. M. et al. Health-related quality of life, psychological distress, and sexual changes following prostate cancer: a comparison of gay and bisexual men with heterosexual men. J. Sex. Med. 13, 425–434 (2016).
Wassersug, R. J., Lyons, A., Duncan, D., Dowsett, G. W. & Pitts, M. Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer. Urology 82, 565–571 (2013).
Penney, K. L. et al. Gleason grade progression is uncommon. Cancer Res. 73, 5163–5168 (2013).
Santillo, V. M. & Lowe, C. F. Prostate cancer and the gay male. J. Gay Lesbian Psychother. 9, 9–27 (2005).
Gates, G. J. Sexual minorities in the 2008 general social survey: coming out and demographic characteristics. Williams Institute https://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-Sexual-Minorities-2008-GSS-Oct-2010.pdf (2010).
Gates, G. J. In US, more adults identifying as LGBT. GALLUP http://news.gallup.com/poll/201731/lgbt-identification-rises.aspx (2017).
Kleinmann, N. et al. The effect of ethnicity and sexual preference on prostate-cancer-related quality of life. Nat. Rev. Urol. 9, 258–265 (2012).
American Cancer Society. Hormone therapy for prostate cancer. American Cancer Society https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html (2019).
Thomas, C. An analysis of postings on two prostate cancer discussion boards Gay Lesbian Issues. Psychol. Rev. 8, 15–21 (2012).
Rosser, B. R. S. et al. What gay and bisexual men treated for prostate cancer are offered and attempt as sexual rehabilitation for prostate cancer: results from the Restore Study. Urol. Pract. 5, 187–191 (2018).
Resnick, M. J. et al. Long-term functional outcomes after treatment for localized prostate cancer. N. Engl. J. Med. 368, 436–445 (2013).
Cooperberg, M. R., Broering, J. M. & Carroll, P. R. Time trends and local variation in primary treatment of localized prostate cancer. J. Clin. Oncol. 28, 1117–1123 (2010).
Hamilton, A. S. et al. Trends in the treatment of localized prostate cancer using supplemented cancer registry data. BJU Int. 107, 576–584 (2011).
Allensworth-Davies, D. et al. The health effects of masculine self-esteem following treatment for localized prostate cancer among gay men. LGBT Health 3, 49–56 (2015).
Deimling, G. T., Bowman, K. F., Sterns, S., Wagner, L. J. & Kahana, B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psychooncology 15, 306–320 (2006).
Torbit, L. A., Albiani, J. J., Crangle, C. J., Latini, D. M. & Hart, T. L. Fear of recurrence: the importance of self-efficacy and satisfaction with care in gay men with prostate cancer. Psychooncology 24, 691–698 (2015).
Lubeck, D. P. et al. The CaPSURE database: a methodology for clinical practice and research in prostate cancer. CaPSURE Research Panel. Cancer of the Prostate Strategic Urologic Research Endeavor. Urology 48, 773–777 (1996).
Hart, S. L., Latini, D. M., Cowan, J. E., Carroll, P. R. & Ca, P. I. Fear of recurrence, treatment satisfaction, and quality of life after radical prostatectomy for prostate cancer. Support Care Cancer 16, 161–169 (2008).
Schroeck, F. R. et al. Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy. Eur. Urol. 54, 785–793 (2008).
Cochran, S. D., Mays, V. M. & Sullivan, J. G. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J. Consult. Clin. Psychol. 71, 53–61 (2003).
Mills, T. C. et al. Distress and depression in men who have sex with men: the Urban Men’s Health Study. Am. J. Psychiatry 161, 278–285 (2004).
Zaider, T., Manne, S., Nelson, C., Mulhall, J. & Kissane, D. Loss of masculine identity, marital affection, and sexual bother in men with localized prostate cancer. J. Sex. Med. 9, 2724–2732 (2012).
Thomas, C., Wootten, A. C., Robinson, P., Law, P. C. F. & McKenzie, D. P. The impact of sexual orientation on body image, self-esteem, urinary and sexual functions in the experience of prostate cancer. Eur. J. Cancer Care (Engl.) 27, e12827 (2018).
Heerdegen, A. C. S., Petersen, G. S. & Jervelund, S. S. Determinants of patient satisfaction with cancer care delivered by the Danish healthcare system. Cancer 123, 2918–2926 (2017).
Dowrick, A. S., Wootten, A. C. & Botti, M. Does partnership status affect the quality of life of men having robotic-assisted radical prostatectomy (RARP) for localised prostate cancer? Appl. Nurs. Res. 42, 51–55 (2018).
Segrin, C., Badger, T. A. & Figueredo, A. J. Stage of disease progression moderates the association between social support and depression in prostate cancer survivors. J. Psychosoc. Oncol. 29, 552–560 (2011).
Kamen, C. et al. The association between partner support and psychological distress among prostate cancer survivors in a nationwide study. J. Cancer Surviv. 9, 492–499 (2015).
Jan, M. et al. The roles of stress and social support in prostate cancer mortality. Scand. J. Urol. 50, 47–55 (2016).
Capistrant, B. D. et al. Social support and health-related quality of life among gay and bisexual men with prostate cancer. Oncol. Nurs. Forum 45, 439–455 (2018).
DuVall, E. Same-sex marriage rate lower than rate for straight couples, poll shows. UPI https://www.upi.com/Top_News/US/2017/06/23/Same-sex-marriage-rate-lower-than-rate-for-straight-couples-poll-shows/8651498232582 (2017).
Elwood, W. N., Irvin, V. L., Sun, Q. & Breen, N. Measuring the influence of legally recognized partnerships on the health and well-being of same-sex couples: utility of the California Health Interview Survey. LGBT Health 4, 153–160 (2017).
Fredriksen-Goldsen, K. I. et al. The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults (Institute for Multigenerational Health, 2011).
Aizer, A. A. et al. Marital status and survival in patients with cancer. J. Clin. Oncol. 31, 3869–3876 (2013).
Patterson, C. Family relationships of lesbians and gay men. J. Marriage Fam. 62, 1052–1069 (2000).
Dowsett, G. W. “Losing my chestnut”: one gay man’s wrangle with prostate cancer. Reprod. Health Matters 16, 145–150 (2008).
Oswald, R. F. et al. Resilience within the family networks of lesbians and gay men: intentionality and redefinition. J. Marriage Fam. 64, 374–383 (2002).
Kurdek, L. A. Are gay and lesbian cohabiting couples really different from heterosexual married couples. J. Marriage Fam. 66, 880–900 (2004).
Kurdek, L. A. What do we know about gay and lesbian couples? Curr. Dir. Psychol. Sci. 14, 251–254 (2005).
Smith, J. A., Filiault, S. M., Drummond, M. J. & Knapman, R. J. The psychosocial impact of prostate cancer on patients and their partners. Med. J. Aust. 186, 159–160 (2007).
Kurdek, L. Differences between heterosexual-nonparent couples and gay, lesbian and heterosexual-parent cohabitating couples. J. Marriage Fam. 60, 553–568 (2001).
Cornell, D. A gay urologist’s changing views of prostate cancer. J. Gay Lesbian Psychother. 9, 29–41 (2005).
Asencio, M., Blank, T., Descartes, L. & Crawford, A. The prospect of prostate cancer: a challenge for gay men’s sexualities as they age. Sex. Res. Social Policy 6, 38–51 (2009).
Higgins, G. A gay man and his partner face his prostate cancer together. J. Gay Lesbian Psychother. 9, 147–153 (2005).
Santillo, V. M. Prostate cancer diagnosis and treatment of a 33-year-old gay man. J. Gay Lesbian Psychother. 9, 155–171 (2005).
Capistrant, B. D. et al. Caregiving and social support for gay and bisexual men with prostate cancer. Psychooncology 25, 1329–1336 (2016).
Jackson, L. Surviving yet another challenge. J. Gay Lesbian Psychother. 9, 101–107 (2005).
Parkin, R. P. & Girven, H. Together with prostate cancer. J. Gay Lesbian Psychother. 9, 137–146 (2005).
Kamen, C. & Darbes, L. in Gay and Bisexual Men Living with Prostate Cancer: from Diagnosis to Recovery (eds Perz, J., Ussher, J. M. & Rosser, B. R. S.) 68–84 (Harrington Park Press, LLC, 2018).
Darbes, L. A. & Lewis, M. A. HIV-specific social support predicts less sexual risk behavior in gay male couples. Health Psychol. 24, 617–622 (2005).
Thomas, C., Wootten, A. & Robinson, P. The experiences of gay and bisexual men diagnosed with prostate cancer: results from an online focus group. Eur. J. Cancer Care (Engl.) 22, 522–529 (2013).
Harris, J. Living with prostate cancer: one gay man’s experience. J. Gay Lesbian Psychother. 9, 109–117 (2005).
Latini, D. M., Hart, S. L., Coon, D. W. & Knight, S. J. Sexual rehabilitation after localized prostate cancer: current interventions and future directions. Cancer J. 15, 34–40 (2009).
Schaffner, B. Prostate cancer at age 84. J. Gay Lesbian Psychother. 9, 131–136 (2005).
Rose, D., Ussher, J. M. & Perz, J. Let’s talk about gay sex: gay and bisexual men’s sexual communication with healthcare professionals after prostate cancer. Eur. J. Cancer Care (Engl.) 26, e12469 (2017).
Quinn, G. P., Schabath, M. B., Sanchez, J. A., Sutton, S. K. & Green, B. L. The importance of disclosure: lesbian, gay, bisexual, transgender/transsexual, queer/questioning, and intersex individuals and the cancer continuum. Cancer 121, 1160–1163 (2015).
Wong, W. K. T. et al. Prostate Cancer Information Needs of Australian Gay and Bisexual Men (Prostate Cancer Foundation of Australia, Sydney, 2013).
Filiault, S. M., Drummond, M. J. N. & Smith, J. A. Gay men and prostate cancer: voicing the concerns of a hidden population. J. Mens Health 5, 327–332 (2008).
Miller, M. Identity and prostate cancer: comments on a messy life. J. Gay Lesbian Psychother. 9, 119–129 (2005).
Ussher, J. M. et al. Talking about sex after cancer: a discourse analytic study of health care professional accounts of sexual communication with patients. Psychol. Health 28, 1370–1390 (2013).
Perz, J., Ussher, J. M. & Gilbert, E. Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals. BMC Cancer 13, 270 (2013).
Ussher, J. M. et al. Threat of sexual disqualification: the consequences of erectile dysfunction and other sexual changes for gay and bisexual men with prostate cancer. Arch. Sex. Behav. 46, 2043–2057 (2016).
Crangle, C. J., Latini, D. M. & Hart, T. L. The effects of attachment and outness on illness adjustment among gay men with prostate cancer. Psychooncology 26, 500–507 (2017).
McConkey, R. W. & Holborn, C. Exploring the lived experience of gay men with prostate cancer: a phenomenological study. Eur. J. Oncol. Nurs. 33, 62–69 (2018).
Hoyt, M. A. et al. Gay men’s experiences with prostate cancer: implications for future research. J. Health Psychol. https://doi.org/10.1177/1359105317711491 (2017).
Frey, A. et al. Prevalence and predicting factors for commonly neglected sexual side effects to external-beam radiation therapy for prostate cancer. J. Sex. Med. 14, 558–565 (2017).
Benson, J. S., Abern, M. R. & Levine, L. A. Penile shortening after radical prostatectomy and Peyronie’s surgery. Curr. Urol. Rep. 10, 468–474 (2009).
Gavin, A. T. et al. Patient-reported ‘ever had’ and ‘current’ long-term physical symptoms after prostate cancer treatments. BJU Int. 116, 397–406 (2015).
Sanda, M. G. et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N. Engl. J. Med. 358, 1250–1261 (2008).
Potosky, A. L. et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J. Natl Cancer Inst. 92, 1582–1592 (2000).
Frey, A. U., Sonksen, J. & Fode, M. Neglected side effects after radical prostatectomy: a systematic review. J. Sex. Med. 11, 374–385 (2014).
Kohler, N. et al. Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study. Eur. J. Cancer Care (Engl.) 23, 795–802 (2014).
Fergus, K. D., Gray, R. E. & Fitch, M. I. Sexual dysfunction and the preservation of manhood: experiences of men with prostate cancer. J. Health Psychol. 7, 303–316 (2002).
Lee, T. K. et al. Impact of prostate cancer treatment on the sexual quality of life for men-who-have-sex-with-men. J. Sex. Med. 12, 2378–2386 (2015).
Goldstone, S. The ups and downs of gay sex after prostate cancer treatment. J. Gay Lesbian Psychother. 9, 43–55 (2005).
Hartman, M. E. et al. Exploring gay couples’ experience with sexual dysfunction after radical prostatectomy: a qualitative study. J. Sex Marital Ther. 40, 233–253 (2014).
Ussher, J. M., Rose, D. & Perz, J. Mastery, isolation, or acceptance: gay and bisexual men’s construction of aging in the context of sexual embodiment after prostate cancer. J. Sex. Res. 54, 802–812 (2017).
Penson, D. F. et al. 5-Year urinary and sexual outcomes after radical prostatectomy: results from the Prostate Cancer Outcomes Study. J. Urol. 179, S40–S44 (2008).
Smith, D. P. et al. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. BMJ 339, b4817 (2009).
Motofei, I. G., Rowland, D. L., Popa, F., Kreienkamp, D. & Paunica, S. Preliminary study with bicalutamide in heterosexual and homosexual patients with prostate cancer: a possible implication of androgens in male homosexual arousal. BJU Int. 108, 110–115 (2011).
Savic, I., Berglund, H. & Lindstrom, P. Brain response to putative pheromones in homosexual men. Proc. Natl Acad. Sci. USA 102, 7356–7361 (2005).
Berglund, H., Lindstrom, P. & Savic, I. Brain response to putative pheromones in lesbian women. Proc. Natl Acad. Sci. USA 103, 8269–8274 (2006).
Savic, I. & Lindstrom, P. PET and MRI show differences in cerebral asymmetry and functional connectivity between homo- and heterosexual subjects. Proc. Natl Acad. Sci. USA 105, 9403–9408 (2008).
Motofei, I. G. A dual physiological character for sexual function: libido and sexual pheromones. BJU Int. 104, 1702–1708 (2009).
Gotta, G. et al. Heterosexual, lesbian, and gay male relationships: a comparison of couples in 1975 and 2000. Fam. Process 50, 353–376 (2011).
Solomon, S. E., Rothblum, E. D. & Balsam, K. F. Money, housework, sex, and conflict: same-sex couples in civil unions, those not in civil unions, and heterosexual married siblings. Sex Roles 52, 561–575 (2005).
Sommers, B. D. et al. Predictors of patient preferences and treatment choices for localized prostate cancer. Cancer 113, 2058–2067 (2008).
Bancroft, J., Carnes, L., Janssen, E., Goodrich, D. & Long, J. S. Erectile and ejaculatory problems in gay and heterosexual men. Arch. Sex. Behav. 34, 285–297 (2005).
Gebert, S. Are penile prostheses a viable option to recommend for gay men. Int. J. Urol. Nurs. 8, 111–113 (2014).
Prestage, G., Hurley, M. & Brown, G. “Cum play” among gay men. Arch. Sex. Behav. 42, 1347–1356 (2013).
Schilder, A. J. et al. ‘It’s like the treasure’: beliefs associated with semen among young HIV-positive and HIV-negative gay men. Cult. Health Sex. 10, 667–679 (2008).
Walz, J. et al. Ejaculatory disorders may affect screening for prostate cancer. J. Urol. 178, 232–237 (2007).
Helgason, A. R. et al. Waning sexual function — the most important disease-specific distress for patients with prostate cancer. Br. J. Cancer 73, 1417–1421 (1996).
Le, J. D. et al. Changes in specific domains of sexual function and sexual bother after radical prostatectomy. BJU Int. 106, 1022–1029 (2010).
Letts, C., Tamlyn, K. & Byers, E. S. Exploring the impact of prostate cancer on men’s sexual well-being. J. Psychosoc. Oncol. 28, 490–510 (2010).
O’Neil, B. B. et al. Climacturia after definitive treatment of prostate cancer. J. Urol. 191, 159–163 (2014).
Rosser, B. R. et al. The effects of radical prostatectomy on gay and bisexual men’s mental health, sexual identity and relationships: qualitative results from the Restore Study. Sex. Relation. Ther. 31, 446–461 (2016).
Savoie, M., Kim, S. S. & Soloway, M. S. A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. J. Urol. 169, 1462–1464 (2003).
Moskowitz, D. A., Rieger, G. & Seal, D. W. Narcissism, self-evaluations, and partner preferences among men who have sex with men. Pers. Individ. Dif. 46, 725–728 (2009).
Rosser, B. R. S. et al. What gay and bisexual men treated for prostate cancer want in a sexual rehabilitation program: results of the Restore Needs. Assessment. Urol. Pract. 5, 192–197 (2018).
Ussher, J. M., Perz, J., Rose, D., Kellett, A. & Dowsett, G. Sexual rehabilitation after prostate cancer through assistive aids: a comparison of gay/bisexual and heterosexual men. J. Sex. Res. https://doi.org/10.1080/00224499.2018.1476444 (2018).
Hart, T. A. et al. Sexual behavior among HIV-positive men who have sex with men: what’s in a label? J. Sex. Res. 40, 179–188 (2003).
Dowsett, G. W., Lyons, A., Duncan, D. & Wassersug, R. J. Flexibility in men’s sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex. Med. 2, 115–120 (2014).
Bokhour, B. G., Clark, J. A., Inui, T. S., Silliman, R. A. & Talcott, J. A. Sexuality after treatment for early prostate cancer: exploring the meanings of “erectile dysfunction”. J. Gen. Intern. Med. 16, 649–655 (2001).
Komisaruk, B. R., Whipple, B., Nasserzadeh, S. & Beyer-Flores, C. The Orgasm Answer Guide 108–109 (Johns Hopkins University Press, 2009).
Wassersug, R. J., Westle, A. & Dowsett, G. W. Men’s sexual and relational adaptations to erectile dysfunction after prostate cancer treatment. Int. J. Sexual Health 29, 69–79 (2018).
Lee, T. K., Breau, R. H. & Eapen, L. Pilot study on quality of life and sexual function in men-who-have-sex-with-men treated for prostate cancer. J. Sex. Med. 10, 2094–2100 (2013).
Rosen, R. C. et al. Development and validation of four-item version of Male Sexual Health Questionnaire to assess ejaculatory dysfunction. Urology 69, 805–809 (2007).
Wei, J. T., Dunn, R. L., Litwin, M. S., Sandler, H. M. & Sanda, M. G. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 56, 899–905 (2000).
Coyne, K. et al. The International Index of Erectile Function: development of an adapted tool for use in HIV-positive men who have sex with men. J. Sex. Med. 7, 769–774 (2010).
International Commission on Radiological Protection. Radiation safety aspects of brachytherapy for prostate cancer using permanently implanted sources. A report of ICRP Publication 98. Ann. ICRP 35, 3–50 (2005).
Dauer, L. T., Zelefsky, M. J., Horan, C., Yamada, Y. & St Germain, J. Assessment of radiation safety instructions to patients based on measured dose rates following prostate brachytherapy. Brachytherapy 3, 1–6 (2004).
Nasser, N. J., Cohen, G. N., Dauer, L. T. & Zelefsky, M. J. Radiation safety of receptive anal intercourse with prostate cancer patients treated with low-dose-rate brachytherapy. Brachytherapy 15, 420–425 (2016).
Ash, D. et al. ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother. Oncol. 57, 315–321 (2000).
Centers for Disease Control and Prevention. HIV among gay and bisexual men. CDC https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf (2019).
Burgi, A. et al. Incidence and risk factors for the occurrence of non-AIDS-defining cancers among human immunodeficiency virus-infected individuals. Cancer 104, 1505–1511 (2005).
Bedimo, R. J., McGinnis, K. A., Dunlap, M., Rodriguez-Barradas, M. C. & Justice, A. C. Incidence of non-AIDS-defining malignancies in HIV-infected versus noninfected patients in the HAART era: impact of immunosuppression. J. Acquir. Immune Defic. Syndr. 52, 203–208 (2009).
Patel, P. et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann. Intern. Med. 148, 728–736 (2008).
Hernandez-Ramirez, R. U., Shiels, M. S., Dubrow, R. & Engels, E. A. Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. Lancet HIV 4, e495–e504 (2017).
Robbins, H. A. et al. Excess cancers among HIV-infected people in the United States. J. Natl Cancer Inst. 107, dju503 (2015).
Grulich, A. E., van Leeuwen, M. T., Falster, M. O. & Vajdic, C. M. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 370, 59–67 (2007).
Frisch, M., Biggar, R. J., Engels, E. A. & Goedert, J. J. Association of cancer with AIDS-related immunosuppression in adults. JAMA 285, 1736–1745 (2001).
Gallagher, B., Wang, Z., Schymura, M. J., Kahn, A. & Fordyce, E. J. Cancer incidence in New York State acquired immunodeficiency syndrome patients. Am. J. Epidemiol. 154, 544–556 (2001).
Biggar, R. J. et al. Cancer risk in elderly persons with HIV/AIDS. J. Acquir. Immune Defic. Syndr. 36, 861–868 (2004).
Newnham, A., Harris, J., Evans, H. S., Evans, B. G. & Moller, H. The risk of cancer in HIV-infected people in southeast England: a cohort study. Br. J. Cancer 92, 194–200 (2005).
Shiels, M. S., Goedert, J. J., Moore, R. D., Platz, E. A. & Engels, E. A. Reduced risk of prostate cancer in U. S. men with AIDS. Cancer Epidemiol. Biomarkers Prev. 19, 2910–2915 (2010).
Marcus, J. L. et al. Prostate cancer incidence and prostate-specific antigen testing among HIV-positive and HIV-negative men. J. Acquir. Immune Defic. Syndr. 66, 495–502 (2014).
Silverberg, M. J. et al. HIV infection, immunodeficiency, viral replication, and the risk of cancer. Cancer Epidemiol. Biomarkers Prev. 20, 2551–2559 (2011).
van Leeuwen, M. T. et al. Continuing declines in some but not all HIV-associated cancers in Australia after widespread use of antiretroviral therapy. AIDS 23, 2183–2190 (2009).
Park, L. S. et al. Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997–2012. AIDS 30, 1795–1806 (2016).
Dutta, A., Uno, H., Holman, A., Lorenz, D. R. & Gabuzda, D. Racial differences in prostate cancer risk in young HIV-positive and HIV-negative men: a prospective cohort study. Cancer Causes Control 28, 767–777 (2017).
Dal Maso, L. et al. Risk of cancer in persons with AIDS in Italy, 1985–1998. Br. J. Cancer 89, 94–100 (2003).
Grulich, A. E. et al. Rates of non-AIDS-defining cancers in people with HIV infection before and after AIDS diagnosis. AIDS 16, 1155–1161 (2002).
Clifford, G. M. et al. Cancer risk in the Swiss HIV Cohort Study: associations with immunodeficiency, smoking, and highly active antiretroviral therapy. J. Natl Cancer Inst. 97, 425–432 (2005).
Hessol, N. A. et al. The impact of highly active antiretroviral therapy on non-AIDS-defining cancers among adults with AIDS. Am. J. Epidemiol. 165, 1143–1153 (2007).
Ross, L. E. et al. Prostate-specific antigen test use reported in the 2000 National Health Interview Survey. Prev. Med. 38, 732–744 (2004).
Robbins, H. A., Shiels, M. S., Pfeiffer, R. M. & Engels, E. A. Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States. AIDS 28, 881–890 (2014).
Maksimovic-Ivanic, D. et al. HIV-protease inhibitors for the treatment of cancer: repositioning HIV protease inhibitors while developing more potent NO-hybridized derivatives? Int. J. Cancer 140, 1713–1726 (2017).
Pajonk, F., Himmelsbach, J., Riess, K., Sommer, A. & McBride, W. H. The human immunodeficiency virus (HIV)-1 protease inhibitor saquinavir inhibits proteasome function and causes apoptosis and radiosensitization in non-HIV-associated human cancer cells. Cancer Res. 62, 5230–5235 (2002).
Yang, Y. et al. HIV-1 protease inhibitor induces growth arrest and apoptosis of human prostate cancer LNCaP cells in vitro and in vivo in conjunction with blockade of androgen receptor STAT3 and AKT signaling. Cancer Sci. 96, 425–433 (2005).
Satcher Johnson, A., Song, R. & Hall, H. I. Estimated HIV incidence, prevalence, and undiagnosed infections in US states and Washington, DC 2010–2014. J. Acquir. Immune Defic. Syndr. 76, 116–122 (2017).
Vianna, L. E., Lo, Y. & Klein, R. S. Serum prostate-specific antigen levels in older men with or at risk of HIV infection. HIV Med. 7, 471–476 (2006).
Crum, N. F., Spencer, C. R. & Amling, C. L. Prostate carcinoma among men with human immunodeficiency virus infection. Cancer 101, 294–299 (2004).
Marcus, J. L. et al. Survival among HIV-infected and HIV-uninfected individuals with common non-AIDS-defining cancers. Cancer Epidemiol. Biomarkers Prev. 24, 1167–1173 (2015).
Coghill, A. E., Shiels, M. S., Suneja, G. & Engels, E. A. Elevated cancer-specific mortality among HIV-infected patients in the United States. J. Clin. Oncol. 33, 2376–2383 (2015).
Suneja, G. et al. Cancer treatment disparities in HIV-infected individuals in the United States. J. Clin. Oncol. 32, 2344–2350 (2014).
Murphy, A. B. et al. Are HIV-infected men vulnerable to prostate cancer treatment disparities? Cancer Epidemiol. Biomarkers Prev. 23, 2009–2018 (2014).
Huang, W. C., Kwon, E. O., Scardino, P. T. & Eastham, J. A. Radical prostatectomy in patients infected with human immunodeficiency virus. BJU Int. 98, 303–307 (2006).
Kahn, S. et al. Matched cohort analysis of outcomes of definitive radiotherapy for prostate cancer in human immunodeficiency virus-positive patients. Int. J. Radiat. Oncol. Biol. Phys. 83, 16–21 (2012).
Levinson, A., Nagler, E. A. & Lowe, F. C. Approach to management of clinically localized prostate cancer in patients with human immunodeficiency virus. Urology 65, 91–94 (2005).
Ng, T. et al. Preliminary results of radiation therapy for prostate cancer in human immunodeficiency virus-positive patients. Urology 72, 1135–1138 (2008).
O’Connor, J. K., Nedzi, L. A. & Zakris, E. L. Prostate adenocarcinoma and human immunodeficiency virus: report of three cases and review of the literature. Clin. Genitourin. Cancer 5, 85–88 (2006).
Pantanowitz, L., Bohac, G., Cooley, T. P., Aboulafia, D. & Dezube, B. J. Human immunodeficiency virus-associated prostate cancer: clinicopathological findings and outcome in a multi-institutional study. BJU Int. 101, 1519–1523 (2008).
Schreiber, D. et al. Outcomes and tolerance of human immunodeficiency virus—positive U. S. veterans undergoing dose-escalated external beam radiotherapy for localized prostate cancer. Clin. Genitourin. Cancer 12, 94–99 (2014).
Snelgrove, J. W., Jasudavisius, A. M., Rowe, B. W., Head, E. M. & Bauer, G. R. “Completely out-at-sea” with “two-gender medicine”: a qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC Health Serv. Res. 12, 110 (2012).
Deebel, N. A. et al. Prostate cancer in transgender women: incidence, etiopathogenesis, and management challenges. Urology 110, 166–171 (2017).
Holmberg, M., Arver, S. & Dhejne, C. Supporting sexuality and improving sexual function in transgender persons. Nat. Rev. Urol. 16, 121–139 (2019).
Thurston, A. V. Carcinoma of the prostate in a transsexual. Br. J. Urol. 73, 217 (1994).
Molokwu, C. N., Appelbaum, J. S. & Miksad, R. A. Detection of prostate cancer following gender reassignment. BJU Int. 101, 259 (2008).
Sharif, A. et al. The development of prostate adenocarcinoma in a transgender male to female patient: could estrogen therapy have played a role? Prostate 77, 824–828 (2017).
Ellent, E. & Matrana, M. R. Metastatic prostate cancer 35 years after sex reassignment surgery. Clin. Genitourin. Cancer 14, e207–209 (2016).
Turo, R., Jallad, S., Prescott, S. & Cross, W. R. Metastatic prostate cancer in transsexual diagnosed after three decades of estrogen therapy. Can. Urol. Assoc. J. 7, E544–E546 (2013).
van Haarst, E. P., Newling, D. W., Gooren, L. J., Asscheman, H. & Prenger, D. M. Metastatic prostatic carcinoma in a male-to-female transsexual. Br. J. Urol. 81, 776 (1998).
Miksad, R. A. et al. Prostate cancer in a transgender woman 41 years after initiation of feminization. JAMA 296, 2316–2317 (2006).
Dorff, T. B., Shazer, R. L., Nepomuceno, E. M. & Tucker, S. J. Successful treatment of metastatic androgen-independent prostate carcinoma in a transsexual patient. Clin. Genitourin. Cancer 5, 344–346 (2007).
Markland, C. Transexual surgery. Obstet. Gynecol. Annu. 4, 309–330 (1975).
Morgentaler, A. Controversies and advances with testosterone therapy: a 40-year perspective. Urology 89, 27–32 (2016).
Hoffman, M. A., DeWolf, W. C. & Morgentaler, A. Is low serum free testosterone a marker for high grade prostate cancer? J. Urol. 163, 824–827 (2000).
King, K. J., Nicholson, H. D. & Assinder, S. J. Effect of increasing ratio of estrogen: androgen on proliferation of normal human prostate stromal and epithelial cells, and the malignant cell line LNCaP. Prostate 66, 105–114 (2006).
Gooren, L. & Morgentaler, A. Prostate cancer incidence in orchidectomised male-to-female transsexual persons treated with oestrogens. Andrologia 46, 1156–1160 (2014).
Weyers, S. et al. Gynaecological aspects of the treatment and follow-up of transsexual men and women. Facts Views Vis. Obgyn. 2, 35–54 (2010).
Nature Reviews Urology thanks R. Wassersug, S. Rosser and D. Mitteldorf for their contribution to the peer review of this work.
A literature search was performed using MEDLINE via PubMed, EMBASE via Ovid, PsycINFO and Web of Science. Search terms included “gay”, “bisexual”, “sexual minorities”, “homosexual”, “LGBT”, “MSM”, “GBM”, “men who have sex with men”, “HIV”, “human immunodeficiency virus”, “AIDS”, “prostate cancer”, “transgender”, “transsexual” and “prostate neoplasm”. We restricted our search to studies published in English.
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Prostate Cancer UK LGBT group: https://prostatecanceruk.org/get-support/support-groups/lgbt-group
Used to describe people who have physical, romantic and/or emotional attractions to people of the same sex as them. Can encompass men and women, but often the term ‘lesbian’ is used to identify gay women.
An umbrella term with different interpretations; often used by people whose sexual orientation is not solely heterosexual.
Used to describe people who can develop physical, romantic and/or emotional attractions to either gender.
A term for people whose gender that they identify with or externally manifest (for example, through clothes, name or behaviour) differs from their biological sex.
- Men who have sex with men
(MSM). Men who engage in sexual activity with other men. Includes those who do not self-identify as gay or bisexual.
An outdated term with the same meaning as ‘gay’ that is sometimes regarded as offensive in the lesbian, gay, bisexual and transgender community.
- Masculine self-esteem
How masculine one feels or, in other words, how whole of a man they feel.
- PSA concern
The degree of concern or anxiety that the patient feels with monitoring and how comfortable they feel knowing their serum PSA value.
How much the patient feels that dealing with cancer has contributed to making them stronger or giving them a better outlook on life.
- Sexual confidence
Confidence regarding one’s own sexuality, sexual orientation and sexual capability.
- Disease-specific support
Support of specific behaviours that improve the disease and supportive attitudes towards the disease.
About this article
Cite this article
Amarasekera, C., Wong, V., Yura, E. et al. Prostate cancer in sexual minorities and the influence of HIV status. Nat Rev Urol 16, 404–421 (2019). https://doi.org/10.1038/s41585-019-0194-2
Nature Reviews Urology (2021)
Psychosocial contributors to patients’ and partners’ postprostate cancer sexual recovery: 10 evidence-based and practical considerations
International Journal of Impotence Research (2021)
International Journal of Impotence Research (2021)