Prostate facts for gay and bisexual men

In many ways, prostate cancer and other prostate problems are the same for men whatever their sexuality – gay, bisexual or heterosexual.

But if you are gay, bisexual or a man who has sex with men, you might have some specific questions or concerns.

On this page there’s some information that may be more relevant to you as a gay or bisexual man, or a man who has sex with men - there are also lots of links to the other more detailed information on our website.

Everyone is different, so if the information here is not quite right for you then you should be able to find what you need on our other information pages. If you have any other questions or need more support, get in touch with our Specialist Nurses on our confidential helpline.

On this page

Prostate problems and prostate cancer

The three most common prostate problems are:

For some men, problems urinating could be a sign that they have a prostate problem, usually an enlarged prostate. Or it might be an infection or inflammation of the prostate, called prostatitis. Early prostate cancer doesn't usually cause problems urinating.

Problems with urinating could also be caused by another health problem, such as diabetes, or by any medicines you are taking, such as anti-depressants.

If you've got symptoms, get them checked out by your doctor. Find out more about symptoms to look out for.

There’s no evidence that gay or bisexual men are more likely to get prostate cancer or other prostate problems. But prostate cancer is the most common cancer in men in the UK. About 1 in 8 men will get prostate cancer at some point in their lives. Older men, men with a family history of prostate cancer and Black men have a higher risk.

Find out more about your risk of prostate cancer.

If you are over 50, a Black man, or have a close relative who has had prostate cancer - or if you have symptoms such as problems peeing - you might want to get further advice or a check-up at your GP surgery.

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Testing for prostate cancer

There is no single test to diagnose prostate cancer, but there are a number of tests which can be used to see if you have a prostate problem. These include a blood test known as the PSA test, physical examination of your prostate (called a digital rectal examination or DRE), and a prostate biopsy.

Read more about tests for prostate problems and prostate cancer.

The PSA test

The PSA test measures the total amount of prostate specific antigen (PSA) in your blood. PSA is produced by the prostate. It’s normal to have a small amount of PSA in your blood, and the amount rises as you get older.

A PSA test alone can’t tell you whether you have prostate cancer, and there are pros and cons to having one. If you’re thinking about having a PSA test, it’s important to find out more about it first, so you know the facts before you decide.

Certain things might cause the PSA level to rise for just a short while – and make the test results misleading. This includes being the receptive partner (the ‘bottom’) during anal sex or stimulation of the prostate, so it might be wise to avoid this in the week before a PSA test.

Find out more about the PSA test and what else can affect your PSA levels.

Digital rectal examination (DRE)

The DRE is a common way of helping to diagnose a prostate problem. Your doctor or nurse feels the prostate gland through the wall of the back passage (rectum). Find out more about the DRE test.

Prostate biopsy

If your test results suggest you may have a problem with your prostate, your GP will refer you to a hospital specialist who will then decide if you need further tests, such as a biopsy. A prostate biopsy takes tiny pieces of the prostate to look at under a microscope for signs of cancer. The biopsy involves having a probe inserted into the rectum (back passage).

There are some short-term effects of a biopsy. One side effect is blood in your semen - some men have a bit of blood, others have a lot. Your semen may look blood-stained. Wear a condom if you are having sex during this time.  

Read more about the biopsy and the other side effects.

If you are the receptive partner (‘bottom’) during anal sex, ideally wait for around six weeks after a biopsy before having sex. Ask your doctor or nurse at the hospital for further advice.

Read more about speaking with health professionals below.

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Treatments for prostate cancer

Your treatment options will depend on whether your cancer is contained within the prostate gland (localised), has spread just outside of the prostate (locally advanced) or has spread to other parts of the body (advanced).

You may have a choice of treatments. Your doctor or specialist nurse will explain all your treatment options, and help you to choose the right one for you.

Each treatment has its own advantages and disadvantages. Your personal preferences are very important – think about how the treatment and its side effects will fit into your life.

You might find it helpful to get support, information and advice before choosing. 

Read more about the treatments for prostate cancer.

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Side effects of prostate cancer treatment

Depending on what treatment you have, side effects can include problems with erections, urinary problems (for example leaking urine), bowel problems and tiredness.

You’ll have your own reasons for considering one treatment over another, including how side effects could affect your lifestyle. For example, if you are the receptive partner (‘bottom’) during anal sex you might want to find out about different types of radiotherapy or a treatment called brachytherapy, which aim to reduce the risk of damage to areas around the prostate – including the bowel and the back passage. Not everyone will be able to have these treatments, so speak to your doctor or nurse to find out more or read more about choosing a treatment.

As well as discussing your treatment options with your partner, family or friends, it’s worth talking the decision over with your health professionals. Consider letting them know about your sexuality and lifestyle so they know how treatment could have an impact on you and so they can give you specific information and support.

Find out more about speaking with health professionals below.

Find out more about treatment side effects and ways to manage them on our living with prostate cancer pages.

Sexual side effects

Having treatment for prostate cancer can affect:

  • how you feel about yourself sexually
  • your desire to have sex (libido)
  • your ability to get an erection (erectile function)
  • your ability to ejaculate and have an orgasm
  • your sexual satisfaction
  • your fertility
  • the appearance of your body
  • your relationships.

For more detailed information on the risks of sexual problems for each different prostate cancer treatment, read our treatment pages.

The way that sexual side effects affect you could depend on your approach to sex, sensuality and intimacy. Not all gay and bisexual men have anal sex – but if you do, then the impact of side effects will depend on whether you identify as a ‘top’, a ‘bottom’ or ‘versatile’.

Experience of sex

If you have a partner or you are sexually active then coping with cancer and side effects may have changed your relationship and the way you have sex.

Your sex life is unlikely to be the same as it was before cancer - but you don't have to give up on having closeness, pleasure or fun. Keeping some kind of physical closeness alive, in whatever ways possible, can protect or even improve your relationship.

Prostate cancer and your sex life provides practical tips to help with your sex life, further information about sex therapy and specific information for partners.

If you’re the receptive partner (‘bottom’) during anal sex a lot of the pleasure comes from the penis rubbing against the prostate, and for this reason it is often referred to as the male g-spot. Some men who are the receptive partner during anal sex find that if they have surgery to remove their prostate (radical prostatectomy) or radiotherapy, their experience of sex changes.

With all sexual changes you may be able to find ways to work through this and find new ways of giving and receiving pleasure and keeping closeness or intimacy alive.

Find out more about prostate cancer, sex and relationships.

Watch Martin’s story, for one gay man’s experience of dealing with the impact of prostate cancer on sex and relationships.

Erection problems

To be the active partner (the ‘top’) during anal sex you normally need a strong erection, so erection problems can be a particular issue. You could try using a constriction ring around your penis together with another treatment like tablets (such as Viagra), to help keep your erection hard enough for anal sex.

There are also other treatments for erection problems such as vacuum pumps, injections and pellets.

Speak to your GP or doctor or nurse at the hospital to find out more about treatments for sexual problems. They might refer you to a specialist service such as an erectile dysfunction (ED) clinic.

Find out more about speaking with health professionals below.

Bowel problems and anal sensitivity

If you are the receptive partner (‘bottom’) during anal sex, then bowel problems after radiotherapy may be a particular issue. Some men also find that the skin inside their anus is more sensitive after radiotherapy.

If you are experiencing bowel problems or sensitivity in this area then wait until these issues have subsided before trying anal play or sex. Although short-term problems in the back passage usually settle down within six weeks of finishing treatment, there can be some permanent changes in the anal canal.

It’s wise to be cautious and perhaps less adventurous than you were before your treatment. Talk to your doctor or nurse for further advice.

Find out more about speaking with health professionals below.

Use a condom and try extra lubrication once any sensitivity settles down. Use water soluble or silicone-based lubricants; never use oil-based lubricants such as body lotions, massage oils or Vaseline, as they can cause the condom to break.

Cleaning yourself before sex can make you feel more comfortable, but douching can irritate the lining of your back passage, making it more vulnerable to infections. So you may prefer to just clean the external area, rather than cleaning inside. GMFA provide more general advice about douching.

Find out more about managing bowel problems.

Ejaculation and orgasm

After surgery for prostate cancer (radical prostatectomy) you will no longer be able to ejaculate semen, although you will still be able to have an orgasm. Some men say that this also changes their experience of sex, but after time some men can adapt to it.

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HIV and prostate cancer

HIV (human immunodeficiency virus) doesn’t only affect gay and bisexual men, but as a population gay and bisexual men are more likely to be affected by HIV. This information answers particular questions that gay and bisexual men have asked us about HIV and prostate cancer.

There is evidence that some cancers – such as anal cancer, lung cancer and some lymphomas – are more common in people living with HIV. Researchers have looked at whether men with HIV are more likely to develop prostate cancer. At the moment, we don’t know for sure. But there is research that shows that men with HIV can still benefit from treatments for prostate cancer like surgery and radiotherapy. And these men don’t seem to get increased side effects.

Some medicines used to treat cancer can interact with medicines to treat HIV or conditions associated with HIV. If you do have HIV and prostate cancer, it’s important that health professionals specialising in HIV and cancer discuss the best treatment options for you. It is also very important that your doctors know about all the medication you take, including over-the-counter and herbal remedies and any recreational drugs.

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Speaking with health professionals

Some men find that their doctor or nurse assumes that they are heterosexual. Health professionals don’t record people’s sexuality as a standard. But it can help to let your doctor or nurse know about your sexuality and bring your partner to appointments. It can be helpful if you want specific information or support, and including your partner or loved one can mean you feel more supported during appointments.

Most health professionals will have equality and diversity training and the NHS has a legal duty to treat people fairly, which means it’s illegal to discriminate against you because of your sexual orientation. It is your right to have the same standard of care and treatment as heterosexual men.

But if you feel your rights are not being respected, you can complain. If you live in England contact your nearest Patient Advice and Liaison Service (PALS) at your local hospital or through NHS Choices. Find out more about raising concerns or complaints about healthcare in Scotland, Wales or Northern Ireland. Or contact Stonewall’s Information Service.

You could also seek advice about the impact on your sex life at a Genito-urinary Medicine (GUM) clinic or sexual health clinic. They know a lot about sexual issues, and may be able to advise about what can help.

Including your partner

If you are in a civil partnership then you have the same healthcare rights as a married couple. A civil partnership also gives your partner the right to be your nearest relative. This means that they can be involved in decisions about your healthcare.

If you're not in a civil partnership but do have a partner or boyfriend, then you can nominate them as your point of contact or ‘next of kin’. Next of kin can be anybody in your social or family network. Staff must respect your wishes about who this is.

If you give permission, your partner, boyfriend or friend can:

  • be involved in medical appointments
  • be included in discussions about your diagnosis, treatment and care
  • make sure your wishes are represented.

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Getting more support

All Prostate Cancer UK services are open to everyone, whether you are gay, bisexual, transgender, heterosexual, single or in a relationship. Partners can also use our services.

There are other men who’ve been through similar experiences, and you might find it helpful to be in touch with them through our peer support service. Let us know if you’d prefer to talk to a gay or bisexual man.

You may also want to talk to gay and bisexual organisations such as The Lesbian and Gay Foundation, GMFA, Stonewall, Health with Pride, LLGS Helpline and Malecare.

The Canadian Cancer Society have also produced a series of films about gay men confronting prostate cancer.

There are some support groups in the UK for gay and bisexual men with prostate cancer.

Out with Prostate Cancer

  • The group meets at the Lesbian and Gay Foundation in Manchester.
  • They meet on the first Saturday of every month between 2-4pm.
  • The group offers a safe and confidential environment to discuss your concerns and experiences with other gay and bisexual men who deal with the same problems.
  • Although the group meets in Manchester, it is keen to offer support to gay and bisexual men throughout the country.
  • For more information email outwithprostatecancer@yahoo.co.uk 

Midlands Gay, Bisexual and Trans Prostate Cancer Support Group

  • The group meets at the Birmingham LGBT centre, 38/40 Holloway Circus, Birmingham, B1 1EQ. The centre is located in Birmingham city centre, a short walk from New Street station.
  • The group meets on the last Monday of every month at 7.00-9.00 pm.
  • For more details contact Dave Viney on 0121 643 1160 or email davidviney@blgbt.org 

METRO WALNUT -  prostate cancer group for gay and bisexual men

  • The group is for to gay, bisexual and men who have sex with men and their partners. It is also open to any transexual women on a one to one basis and to the main group by invitation.
  • The group meets at Metro’s Greenwich office at 141 Greenwich High Rd, Greenwich, London SE10 8JA. Transport links with mainline Greenwich station and DLR station both 3-4 minutes walk from the venue.
  • They meet on the third Saturday on the month from 2-4pm.
  • For more information, contact Simon Faulkner on 07779 032 263 or email simon@metrocentreonline.org

More support groups for gay and bisexual men may be set up in the near future, look out for information on our support groups page.

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Reviewers

This publication was written and edited by:

Prostate Cancer UK's Information Team.

It was reviewed by:

Dawn Doran, PhD Researcher, “The lived experience of gay men with prostate cancer, University of Central Lancashire, Preston, Lancashire

Darryl Mitteldorf, Licensed Clinical Social Worker, Executive Director, Malecare Cancer Support, New York, USA

Editorial team at NAM, the HIV information charity, London

Mark Pedder, Macmillan Urology & Oncology CNS, Luton & Dunstable Hospital, Luton

Sean Ralph, Health and Care Professions Council registered Therapy Radiographer & Out with Prostate Cancer support group Treasurer, Manchester

Dr. Daniel Saunders, Consultant in Clinical Oncology, Nottingham University Hospitals NHS Trust

James Taylor, Senior Health Officer, Stonewall, London

Dr Tim Wong, Senior Project Officer – Awareness and Education, Prostate Cancer Foundation of Australia

Prostate Cancer UK volunteers and other gay and bisexual men affected by prostate problems and prostate cancer

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References

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