Prostate cancer tests and treatment: A guide for gay and bisexual men

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This page is for gay and bisexual men, and men who have sex with men, who are having tests or treatment for prostate cancer. Partners and family members may also find it useful.

Other information and support that you may find helpful includes:

our booklet for gay and bisexual men, which you can order or download for free
information for trans women
real life stories, including some from gay or bisexual men
our online chat group for gay and bisexual men
local support groups, including some for gay and bisexual men and their partners
our online community – you can post a comment anywhere but there’s a specific section for gay and bisexual men
our Specialist Nurses – call them or chat to them online.

Prostate cancer in gay and bisexual men

Prostate cancer isn’t more common in gay or bisexual men, or in men who have anal sex, and it’s treated in the same way. But if you’re gay, bisexual or a man who has sex with men, you might have some specific questions or concerns. We’ve included information that may be relevant to you, and about the support available.

If you’re a gay or bisexual trans man (assigned female at birth but identify as a man) you will not have a prostate so you are not at risk of getting prostate cancer. But you may have a partner who has, or is at risk of getting, prostate cancer.

For more general information about prostate cancer, you can read our information on signs and symptoms or things that can increase your risk of prostate cancer.

Talking about your sexuality with your medical team

It may be helpful to let your medical team know if you’re gay or bisexual, so they can give you the support and information that is right for you. Read about ways to talk about your sexuality with health professionals.

Testing for prostate cancer

Tests for diagnosing prostate cancer are the same for everyone. But this page has information on things to be aware of if you have anal sex or have your prostate stimulated.

The PSA test

This is a blood test that measures the amount of a protein called prostate specific antigen (PSA) in your blood. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer.

Lots of things can affect your PSA level, including being the receptive partner in anal sex (bottom) or having your prostate stimulated. Try to avoid this for a week before having a PSA test.

Find out more about the PSA test, including what to do if you have trouble getting one.

Digital rectal examination (DRE)

This is where your GP feels your prostate through the wall of your back passage (rectum). If your prostate is hard or lumpy, this could be a sign of prostate cancer. Read more about having a DRE.

MRI scan

If your GP thinks you may have a problem with your prostate, they will refer you to a hospital specialist for more tests, such as a magnetic resonance imaging (MRI) scan. This can show whether there is anything unusual in the prostate, or the area around it, that might be cancer.

Prostate biopsy

This involves using thin needles to take small pieces of tissue from the prostate. Depending on the type of biopsy you have, the needle will either go through the wall of the back passage, or through the skin between your testicles and back passage (perineum). The tissue is then looked at under a microscope to check for cancer.

It’s normal to see some blood in your urine or bowel movements for about two weeks after having a biopsy. This will be different for everyone and may vary from a small amount to a much larger amount. You may also notice blood in your semen for a couple of months – it might look red or dark brown. This can be a shock and some men find it distressing, but it’s normal and should get better by itself.

You can still masturbate and have sex if you’re the penetrative partner in anal sex (top), but you might prefer to use a condom until the bleeding stops. If it takes longer than a couple of months to clear up, or gets worse, you should see your doctor.

If you’re the receptive partner in anal sex (bottom), wait about two weeks until any side effects from your biopsy have settled before having anal sex. Talk to your doctor or nurse if you need any further advice.

Read more about having a prostate biopsy, including the possible side effects.

Treatments for prostate cancer

There are several ways to treat or monitor prostate cancer. Some treatments aim to get rid of the cancer completely and others aim to control it. We have information on the different treatments for prostate cancer and choosing a treatment.

Before choosing a treatment, you may find it helpful to get some extra information or support from our Specialist Nurses. You could also talk to your partner, family or friends.

It might also help to contact a prostate cancer support group. There are some support groups specifically for gay and bisexual men with prostate cancer where you can discuss treatments and side effects and the impact they might have on you.

Or you could visit our online community, which has a section for gay and bisexual men, and men who have sex with men.

Side effects of prostate cancer treatment

All treatments have side effects, and some of these may be particularly relevant to you as a gay or bisexual man. Depending on the treatment you have, side effects can include:

sexual side effects
urinary problems
bowel problems
tiredness

We have some specific information on these side effects below, as well as more general information about ways to manage them on our living with prostate cancer pages.

You’ll have your own reasons for choosing one treatment over another, including how the possible side effects could affect your lifestyle. For example, if you’re usually the receptive partner in anal sex (bottom) and you’re thinking about having radiotherapy, you might want to find out about how radiotherapy can affect the bowel and the back passage.

Speak to your doctor or nurse about your treatment options and the possible side effects. Consider telling them about your sexuality and lifestyle so they know how treatment and side effects could affect you. This might also help them to support you better. Read more about talking to health professionals about your sexuality.

Sexual side effects

Treatments for prostate cancer can cause sexual side effects. These include:

how you feel about yourself sexually
your desire to have sex (libido)
your ability to get an erection (erectile function)
not being able to ejaculate and having a dry orgasm
not being able to orgasm
urinating or leaking urine when you orgasm (climacturia)
reduction in penis size
your sexual satisfaction
your ability to have children (fertility).

We talk about some of these side effects below, as well as in our information on sex and relationships. You can also check out our online guide on how to manage sexual side effects.

How 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’re being the ‘top’ or ‘bottom’ partner.

I now think about sex in a completely different way – I try to approach relationships from a friendship point of view first. I’m more sensual and in many ways I find it more relaxing.

A personal experience

Your experience of sex

Dealing with cancer and side effects of treatment may change the way you have or think about sex. It may also affect how you feel about yourself. Many men find changes to their sex life difficult to deal with. We know from research that gay and bisexual men can find these changes particularly difficult to come to terms with.

When you're being the receptive partner in anal sex (bottom), a lot of the pleasure comes from the penis rubbing against the prostate. This is why the prostate is often referred to as the male g-spot. If you prefer to be the receptive partner during anal sex (bottom), your experience of sex will probably change after you’ve had treatment.

If you have radiotherapy, your prostate may feel less sensitive afterwards. Or if you have surgery to remove your prostate (radical prostatectomy), the prostate will no longer be there to stimulate. You should think about these possible changes when deciding which treatment is best for you.

If you're the receptive partner in anal sex (bottom) and you’ve had permanent seed brachytherapy to treat your prostate cancer, there is a risk that your partner might be exposed to some radiation during sex. Your doctor may suggest you avoid having anal sex in the first six months after having permanent seed brachytherapy. Ask your doctor or radiographer for more information about having anal sex after permanent seed brachytherapy. They might be able to give you specific advice about how long to wait before having sex, which is tailored to you and your treatment.

Even though your sex life may not be the same as it was before cancer, you don't have to give up on having pleasure, closeness or fun. It can help to be realistic but flexible in your approach to sex. It may not be possible to find a quick fix, but you may be able to explore new ways of giving and receiving pleasure.

It’s also important to look after yourself and your body. Try to focus on the things you like about yourself. Do activities or hobbies you are good at or try something new. Being physically active can lift your mood, keep your body in shape and may help your sex life.

If you have a new sexual partner or you’re starting to think about dating, you may worry about explaining sexual problems, such as difficulty getting erections, not being able to ejaculate semen or less desire for sex. Fear of rejection or being worried about what other people think about you is normal and everyone has their own worries, whether or not they’ve had cancer.

Talk about your worries with someone you feel comfortable with and ask for support if you need it. Some men find it helpful to attend a support group, where you can share your experiences and get support from others. A charity called Look Good Feel Better also run free skincare and grooming workshops for people with cancer to attend – this may help you feel more confident.

If you’d prefer to talk to someone you don’t know, you could get information and support at a sexual health clinic. They know a lot about sexual issues, and may have ideas that can help. You can also talk to a sex therapist or registered counsellor about sexual problems. And our own Specialist Nurses run a sexual support service, which is a chance for you, or your partner, to talk to a nurse who has an interest in helping with sexual problems after treatment for prostate cancer.

Find out more about prostate cancer, sex and relationships.

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

My husband and I ended up enjoying all sorts of things we never did before my prostate surgery. I used to almost always be the active partner during sex, but now he’s more dominant and it’s been lovely.

A personal experience

Erection problems

If you prefer being the penetrative partner during anal sex (top) you normally need a strong erection. You could try using a constriction ring around the base of your penis. Or some men use a vacuum pump to help with their erection problems. If you decide to try a vacuum pump, a health professional will usually show you how to use it properly. They will fit a constriction ring at the same time, to make sure the ring is the right size for you. Our online guide has a video showing you how to use a pump.

A vacuum pump and constriction ring can be used together with another treatment like tablets, to help keep your erection hard enough for anal sex. There are also other treatments for erection problems, such as injections, pellets and cream. There’s not always a quick fix. You often have to stick with them for a while or try different treatments to see what works best for you.

Watch our videos by Lorraine Grover, Psychosexual Nurse Specialist, for more information about how different treatments work for erection problems.

You could also think about other ways to pleasure yourself and your partner, such as oral sex and masturbation by using your mouth and hands. You don’t always need a strong erection for oral sex. Some men may also decide to change their roles during sex if they have erection problems. Talking to a sex therapist or registered counsellor may help you come to terms with these changes and think of ways you can have a fulfilling sex life.

Changes to ejaculation and orgasm

If you have surgery for prostate cancer (radical prostatectomy), you won’t be able to ejaculate semen, but you may still be able to have a dry orgasm. Some men also ejaculate less semen or stop ejaculating completely after radiotherapy. This can be difficult to come to terms with if you feel you need to ejaculate to enjoy sex, or for your partner to think that you’re enjoying sex. It can take some time to adjust to these changes.

Urinary problems

Treatments for prostate cancer can cause urinary problems such as leaking urine. For many men this improves over time, but it can be a long-term problem. Urinary problems may affect how you feel about your body and about sex, and can make you worry about having oral sex and masturbating.

If you get any urinary problems, tell your doctor, nurse or radiographer. There are treatments to manage them, as well as things you can do to help yourself. Read more about urinary side effects after prostate cancer treatment, or find tips to help manage urinary problems in our interactive online guide.

Bowel problems and anal sensitivity

If you prefer to be the receptive partner during anal sex (bottom), then bowel problems or sensitivity in the anus after radiotherapy may be an issue.

Your doctor, nurse or radiographer may suggest you avoid having anal sex while you are having radiotherapy. If you have bowel problems or a sensitive anus after radiotherapy, you may want to wait until these have settled before trying anal sex again. Although problems in the back passage may settle down after a few months, there can be some permanent changes.

Here are a few ideas for when you feel ready to try anal sex again.

You could try sitting on your partner and moving up and down on his penis so that you have more control of the penetration, and then moving positions if you want to.
Try using a condom and extra lubrication.
Or ask your partner to gently insert a small, well-lubricated dildo until anal sex becomes more comfortable.

Cleaning yourself before sex can also make you feel more comfortable. Some men prefer to just clean the outside area, rather than cleaning inside. Remember that douching before or after sex doesn’t protect you from infections.

Read more about possible bowel problems after prostate cancer treatment.

HIV and prostate cancer

HIV (human immunodeficiency virus) doesn’t only affect gay and bisexual men, but gay and bisexual men are more likely to be affected by HIV than heterosexual men. Current guidelines say that prostate cancer is not more common in men who have HIV.

Studies suggest that treatments for prostate cancer, such as surgery and radiotherapy, do work for men who have HIV. But if you have HIV and are diagnosed with prostate cancer, it’s important to discuss your treatment options with a health professional who specialises in HIV and cancer. It’s important to tell your doctor about all the medicines you take, including over-the-counter and herbal remedies.

If you need tablets to help with erection problems, you may be offered a smaller dose if you’re already taking medication for HIV (antiretroviral drugs). This is because HIV drugs can react with some other medicines, which can cause side effects that may be serious.

If you’ve had a biopsy or surgery for your prostate cancer, you may experience some bleeding afterwards. If you choose to have sex while you are bleeding, it’s important to use a condom. Some bleeding after treatment is normal and should get better by itself. But if it doesn’t get better, or it gets worse, you should talk to your doctor straight away.

Talking about your sexuality

Some men find that their doctor, nurse or radiographer assumes they are heterosexual. All hospitals should ask patients about their sexuality. This helps health professionals to give care and support that is right for each person. Information you give will be recorded confidentially and will stay private. But it’s your choice whether or not you decide to tell them.

You may feel anxious about how to raise the subject or how your doctor or nurse will react if you tell them you’re gay or bisexual. Some men might worry that they will be judged or treated differently because of their sexuality, and we know that some men have had bad experiences in the past. If this has happened to you, you may find it more difficult to be open about your sexuality with your doctor or nurse.

But remember that as a gay or bisexual man you’re entitled to exactly the same standard of care and treatment as a heterosexual man. This means it’s illegal to discriminate against you because of your sexuality. Most health professionals will have had equality and diversity training, and they have a legal duty to provide fair and equal services to all people.

If you’re worried about telling your doctor or nurse about your sexuality, try planning exactly what you’ll say and when you’ll say it. You might find it helpful to take your partner or a friend with you for support. It might be easier to talk about it at the start of your appointment, so that you aren’t worrying about it during the appointment. You might also find it helpful to take this booklet with you to your appointments.

If you feel these rights aren’t being respected, you can contact your local Citizens Advice or visit their website for information about how to complain. Or you can contact the Patient Advice and Liaison Service (PALS) at your local NHS hospital for confidential advice about how to complain. You can also get information and support from Stonewall – a charity that provides information about gay rights.

Don’t be embarrassed or afraid to ask the questions that you really want to ask your doctor – nothing is a silly question and the doctors have heard it all before.

A personal experience

Including your partner, family or friends

Many men find it helpful to bring a partner or friend with them to appointments for extra support. If you’re married to, or in a civil partnership with, someone of the same gender you have the same rights as a person who is married to someone of a different gender – including in healthcare. Your husband or civil partner has an equal right to be your nearest relative. This means they can be involved in decisions about your healthcare.

If you're not married or in a civil partnership, then you can nominate a partner or friend as your ‘next of kin’. Next of kin can be anybody in your social or family group. Some men choose a close friend who they trust. Health professionals must respect your wishes about who this is. If you give permission, your partner or friend can:

go to your medical appointments
be included in discussions about your diagnosis, treatment and care
make sure your wishes are heard.

Prostate Cancer UK's services are free and open to everyone, whether you are gay, bisexual, a trans person, heterosexual, single or in a relationship. Partners and family members can also use our services.

Services include:

our Specialist Nurses
our one-to-one support service – let our Specialist Nurses know if you’d prefer to talk to a gay or bisexual man
our online community – this includes a section for gay and bisexual men, and men who have sex with men.

Our sexual support service

Our sexual support service is a chance for you, or your partner, to talk to one of our Specialist Nurses with an interest in helping with sexual problems after treatment for prostate cancer. They can talk to you in depth about the impact of treatment on your sex life and relationships, and discuss possible treatments or ways to deal with these changes.

Support groups

There are support groups in the UK for gay and bisexual men with prostate cancer. The main ones are listed here.

Out with Prostate Cancer - Manchester
Out with Prostate Cancer - Midlands
METRO Walnut

Gay and bisexual organisations

You may want to talk to organisations that support gay and bisexual men such as:

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

References

Updated: October 2018 | Due for Review: October 2021

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Information for gay and bisexual men

Prostate cancer in gay and bisexual men