Gay men more vulnerable to drops in quality of life after prostate treatment

Nancy Ferrari

Senior editor, Harvard Health

According to a study presented at the American Urological Association’s (AUA) annual meeting in May, gay men treated for prostate cancer have a lower quality-of-life after treatment than the population of prostate cancer patients as a whole. The study, which is the first to measure the impact of prostate cancer on gay men, relied on previously published data from a general population of men treated for the disease as a point of comparison.

Through an Internet-based survey, 92 gay men from the United States and Canada answered questions relating to urinary, bowel, and hormone symptoms. Compared to their heterosexual counterparts, they reported worse physical and mental health functioning, poorer sexual and ejaculatory function, and a greater fear that their cancer would return.

“This is one of the early studies demonstrating that quality of life is more significantly impacted by prostate cancer in the gay population,” said Dr. Tomas Griebling, the AUA spokesman who moderated the press briefing.

Literature on this topic is limited; additional research may help determine why gay men experience the effects of prostate cancer treatment more acutely than straight men. Of note, these findings are considered preliminary because they have not yet been published in a peer-reviewed journal.

Posted May 25, 2011

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  2. John Mulvihill

    Dear fellow prostate cancer survivors: A word of caution about claims of superiority of proton-beam therapy. Like Ryan, who I believe is totally sincere, I too purchased and read “You Can Beat Prostate Cancer” as part of my research into which radiation technology to use in the fight against my gland-contained prostate cancer. I found that book to be overwhelmingly biased in favor of proton-beam, and I was not convinced by it. Which is not to say it isn’t worth reading. The developers of proton-beam were aware of the limitation of early versions of photon-beam radiation: lack of ability to focus on the malignant cells. This required “watering down” radiation levels, thus reducing efficacy, and yet at the same time delivering excessive radiation to healthy cells, resulting in incontinence and other negative side effects.

    From other, independent sources I discovered that over the last couple of decades, photon-beam has been vastly improved, to the point where it zaps the malignant cells with high doses of radiation while sparing healthy tissue and greatly reducing after effects. This new-generation photon-based technology is known as IMRT: Intensity Modulated Radiation Therapy.

    From my research, proton-beam radiation is no more effective for treating prostate cancer than IMRT, which is the standard installation in most cancer treatment centers, nor is it any more free from side effects. Belief in proton-beam has become a quasi-religion among some of its adherents, which is understandable because it probably saved their lives. And the few USA-based institutions that offer proton-beam have aggressive marketing programs designed to attract patients from all over the country, inspired in part by the huge costs if installing and maintaining the equipment.

    To anyone considering traveling to another city for several weeks or even months to get proton-beam treatment, and willing to bear the expense and complications that would ensue, I recommend doing some careful research beforehand and getting independent outcome comparisons between proton-beam and IMRT. Your choice of proton-beam should be fact based, not a case of the grass being greener on the other side of the fence.

    I’m a prostate cancer survivor who opted for IMRT and got the desired results. I did a lot of homework beforehand, and am confident I would have done as well using proton-beam. But that would have meant flying 500 miles and staying in a motel room and eating in restaurants for five weeks, and being alone every moment of that time. I didn’t want to leave my doctors or my comfortable home or, most of all, the support of my family while I was getting treatment. (A reassuring note: the radiation treatment itself is not painful or stress inducing, no matter which technology you opt for.)

    My research indicated to me that for prostate cancer (which proton-beam was not originally designed to treat), there is little or no difference between the two technologies in terms of outcomes and after effects. For example, in “Surviving Prostate Cancer” by Patrick Walsh MD, probably the most respected laymen’s reference about prostate cancer, on page 405 (softcover edition) the book argues that when comparing proton-beam to photon-beam, “. . . cancer cells respond the same way to both. In published reports detailing PSA nadirs, cancer control, and side effects, there are no significant differences seen between proton-beam radiation and other modern radiation techniques.”

    This is not a put-down of proton-beam — both it and IMRT are excellent options if you decide on radiation over surgery. Both technologies are light years ahead of the radiation systems of just A couple of decades ago both in terms of efficacy and freedom from after effects. (Be aware, though, that radiation after effects can make themselves known decades after treatment.)

    My advice to men diagnosed with PCa and considering radiation is not to be influenced by proton-beam “apostles” who mean well but are not fully informed. If your health care provider offers IMRT and you are reasonably close to the treatment center, it’s a lot easier on your pocketbook and emotional state to get your treatment locally. Spending weeks in a lonely motel room in a strange city can, I’ve been told, lead to depression even if you’re perfectly healthy!

    And one more consideration: Your insurer, who has access to all the actuarial data, may be difficult to persuade to pay for proton-beam when equally effective IMRT is offered locally by your healthcare provider.

    Do your research on scientific, unbiased websites, read the patient testimonials and marketing websites with a skeptical eye, and make an informed decision. Either way you’ll be okay!

  3. Ryan

    It depends on the tremeatnt you have. There is a book just out called You Can Beat Prostate Cancer written by Robert J. Marckini a prostate cancer survivor. The book tells alot about prostate cancer and then outlines all of the tremeatnts available today plus the Pros and cons of each including side effects.. It is a great book and any one with prostate cancer or prostate problems should have it.. It can be purchased at Barnes and Noble and on ebay I think plus some other places.I had Prostate Cancer in 2005 and was treated with Proton Radiation at Loma Linda Universtiy Medical Center in Loma Linda California.. Proton Radiation usually has no side effects and has about a 90% cure rate..I personally believe it is the very best tremeatnt available today.. It is very different from conventional radiation in that about 85-90% of the tremeatnt energy is released exactly at the point being treated. Therefore, surrounding tissues and organs are not damaged by the radiation as in conventional radiation.. therefore one has little to no side effects. Proton Radiation basically treats only the area needing to be treated. There is a website called Proton Bob(Bob stands for brotherhood of the ballon) The website is great ..if you or any a friend or relative have Prostate cancer .. please read the website.. and especially read the Patient Testimonial section.. Every one who has ever had Prostate Cancer and was treated with Proton Radiation is completely sold on it.. and why not.. it has no side effects and as good if not better cure rate than all the other tremeatnts..Many doctors have been reluctant to recommend Proton Radition, they didnt know about it, considered it experimental or it was a money thing.. you dont make any money sending your patients somewhere else for tremeatnts.. However some have started to take notice and can no longer ignore the amazing results that Loma Linda Univerty Medical Center has had with it over the last 17 years.. It is now being offered at several other hospitals and several tremeatnt facilities are currenty under construction.. It is offered at M D Anderson in Houston( just opened last may), Mass General in Boston(Harvard) a hospital in Jacksonville florida and one in Indiana I think.. the Proton Bob website gives all the locations There are some really bad side effects with most of the other tremeatnts. With Proton Radiation, it does not effect your sexual ability as most of the other tremeatnts do. I was not sick one day during the tremeatnts or any time after my tremeatnts.. it was like a vacation almost.. Only side effect I had was driving on interstate 10 out in California now that was bad!!!!Ohh my PSA is now .13 and dropping thats point one three!!!!If you have any questions any experience with Prostate Cancer or Proton Radiation, feel free to email me, I will also be glad to visit with you on the phone about it if you or a relative or friend has Prostate Cancer.. Having Prostate cancer was not that big of thing with me especially after having Proton Radiation.. It is a good and simple cure..

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