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Prostate facts for gay and bisexual men

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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.

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.

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.

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.

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.

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.

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.

Contact your local Citizens Advice or visit the website for information about how to complain. You can also get information and support from Stonewall.

Including your partner

Both same sex marriages and civil partnerships carry the same rights as if you were married to someone of the opposite sex, including in healthcare. Your husband or civil partner has an equal right to be your nearest relative. This means that they can be involved in decisions about your healthcare.

If you're not married or in a civil partnership but do have a partner, then you can nominate them as your ‘next of kin’. Next of kin can be anybody in your social or family network. 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 represented.

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 One-to-one service. Let us know if you’d prefer to talk to a gay or bisexual man.

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

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.

Our online group discussions

In partnership with Opening Doors London, we're running a series of online groups for gay and bisexual and men who have sex with men. The groups aim to allow men affected by prostate cancer to share, learn from and gain support from others with similar experiences. You can join the live discussion by video, or audio-only.

Out with Prostate Cancer North West

  • 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
  • We appreciate that some people may not be able to travel to Manchester to attend the meetings so you can also take part the first Saturday of every month using Skype (username: owprostateca)
  • For more information email outwithprostatecancer@yahoo.co.uk

Out with Prostate Cancer Midlands

  • We work with our sister group in Manchester to cover the whole of the Midlands but welcome people from anywhere in the UK
  • 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 second Saturday of every month at 2.00-4.00 pm.
  • For more details contact Eddie Hulme on owprostatecancermidlands@gmail.com

Metro Walnut - A prostate cancer group for gay and bisexual men in London and the South East

  • This is a prostate cancer support group for gay, bisexual men and their male partners and bisexual female partners by invitation (as and when). Trans women can access a one-to-one meeting with the coordinator and access the main group by invitation. Social activities outside of the main meetings are open to everyone.
  • 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 usually meet on the third Saturday of every month from 2-4pm. Please contact Simon to check and reserve a place at the meeting.
  • For more information, contact Simon Faulkner on simon@metrocentreonline.org or visit www.lgbt-walnut.org.uk/

Our online community

Our free online community is a place to talk about whatever’s on your mind – your questions, your ups and your downs. Anyone can ask a question or share an experience. The online community is open to all, but there’s also a section for gay and bisexual men and men who have sex with men. It’s a place to talk to other men who may share or understand your experiences of prostate cancer.

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.

Watch our film about Metro Walnut and the importance of supporting each other.

References

Updated: Nov 2013 | Due for Review: Nov 2015

  • List of references  

    • Blank TO. Gay men and prostate cancer: invisible diversity. Journal of Clinical Oncology 2005; 23:2593.
    • Carballo-Dieguez A, Bauermeister JA, Ventuneac A, Dolezal C, Balan I, Remien RH. The use of rectal douches among HIV-uninfected and infected men who have unprotected receptive anal intercourse: implications for rectal microbicides. AIDS and Behavior, 2008;12(6):860-866.
    • Cornell, D. A gay urologist’s changing views of prostate cancer. In: Perlman, G.; Drescher, J. (eds). A gay man’s guide to prostate cancer. The Haworth Medical Press; Binghamton, NY: 2005. p. 29-41.
    • Dowsett, G.W. “Losing my chestnut” one gay man’s wrangle with prostate cancer. Reprodictive Health Matters 2008:16(32): 145-150.
    • Goldstone, SE. The ups and downs of gay sex after prostate cancer treatment. In: Perlman, G.;Drescher, J.(eds). A Gay Man’s Guide to Prostate Cancer. The Haworth Medical Press; Binghamton, NY: 2005. p. 43-55.
    • Klein LT, Lowe FC. The effects of prostatic manipulation on prostate-specific antigen levels. Urol Clin North Am. 1997 May;24(2):293-7.
    • Mitteldorf, D. Psychotherapy with gay prostate cancer patients. In: Perlman, G.; Drescher, J. (eds). A gay man’s guide to prostate cancer. The Haworth Medical Press; Binghamton, NY: 2005. p. 57-67.
    • National Aids Trust. Men who have sex with men [online] Available from: http://www.nat.org.uk/HIV-Facts/Statistics/Latest-UK-statistics/Men-who-have-sex-with-men.aspx [Accessed September 2013]
    • NHS Choices. Sexuality and gender identity rights [online]. Available from: http://www.nhs.uk/CarersDirect/guide/rights/Pages/LGBT-rights.aspx [Accessed September 2013]
    • Perlman, G. and Drescher, J. Introduction: What gay men (and those near and dear to them) need to know about prostate cancer. Journal of Gay and Lesbian Psychotherapy. (2005), 9:1-2, 1-7
    • Pillet, S. Don’t Ask, Don’t Tell? The unique needs of GLBT patients with Cancer. ONS Connect. January 2011
    • Santillo, V.M and Lowe C. Prostate cancer and the gay male. In: Perlman, G.; Drescher, J. (eds) A gay man’s guide to prostate cancer. The Haworth Medical Press; Binghamton, NY: 2005. p. 29-41.
    • Silberstein, J. Downs, T. Lakin C, Kane C.J. HIV and prostate cancer: A systematic review of the literature. Prostate Cancer and Prostatic Diseases. 2009;12(1):6-12
    • Stonewall. Sexual Orientation: A guide for the NHS. Available online at: http://www.stonewall.org.uk/documents/stonewall_guide_for_the_nhs_web.pdf
    • Tarhan F, Orçun A, Küçükercan I, Camursoy N, Kuyumcuoğlu U. Effect of prostatic massage on serum complexed prostate-specific antigen levels by Urology. 2005 66(6):1234-8.
    • Thomas, C. Wootten, A. Robinson, P. The experiences of gay and bisexual men diagnosed with prostate cancer: results from an online focus group. European Journal of Cancer Care. 2013, 22, 522-529