Developing UK Guidance on How Long Men Should Abstain from Receiving Anal Sex before, During and after Interventions for Prostate Cancer

Prostate cancer has become the most common in England, with 49 029 cases 2018 [[1]Prostate Cancer UK now commonly diagnosed England.2020https://prostatecanceruk.org/about-us/news-and-views/2020/1/prostate-cancer-now-most-commonly-diagnosed-cancer-in-englandDate accessed: June 24, 2021Google Scholar]. One eight men will be during their lifetime [[2]Prostate About prostate cancer: facts and figures.2019https://prostatecanceruk.org/prostate-information/about-prostate-cancerDate This translates to a one four chance of being directly or indirectly affected by for same-sex relationships. Although there is no evidence that who engage relationships are at an increased risk developing cancer, they disproportionately affected, virtue both partners having gland. The sexual side-effects interventions gay bisexual broadly same as those heterosexual men. However, due differences practices may have some additional concerns, more bothersome challenging manage. In quantitative qualitative studies, reported worse function, ejaculatory function bother compared counterparts [3Wassersug R.J. Lyons A. Duncan D. Dowsett G.W. Pitts M. Diagnostic outcome between nonheterosexual treated cancer.Urology. 2013; 82: 565-571https://doi.org/10.1016/j.urology.2013.04.022Abstract Full Text PDF PubMed Scopus (70) Google Scholar, 4Lee T.K. Handy A.B. Kwan W. Oliffe J.L. Brotto L.A. Wassersug et al.Impact treatment on quality life.J Sex. Med. 2015; 12: 2378-2386https://doi.org/10.1111/jsm.13030Abstract (36) 5Hart T.L. Coon D.W. Kowalkowski M.A. Zhang K. Hersom J.I. Goltz H.H. al.Changes roles life after challenges health providers.J 2014; 11: 2308-2317https://doi.org/10.1111/jsm.12598Abstract (77) Erectile dysfunction take penetrative role anal sex require intensive invasive forms treatment, penis needs rigid than it does vaginal [[6]Rosser B.R.S. Merengwa E. Capistrant B.D. Lantaffi Kilian G. Kohil N. al.Prostate gay, bisexual, other men: review.LGBT Health. 2016; 3: 32-41https://doi.org/10.1089/lgbt.2015.0092Crossref For receptive role, gland ‘male G-Spot’. Following surgery, longer pleasurably stimulate and, following radiotherapy, sensitivity erogenous zone can significantly reduced Scholar,[7]Ussher J.M. Perz J. Rose Chambers S. Williams al.Threat disqualification: consequences erectile changes cancer.Arch Behav. 2017; 46 (https://dx.doi.org/10.1007%2Fs10508-016-0728-0): 2043-2057Crossref (48) Men also experience issues pelvic pain rectal irritation [[8]Rosser Polter E.J. Lesher L. Konety B.R. al.The functioning treatment: results from Restore study.Arch 2020; 49: 1589-1600https://doi.org/10.1007/s10508-018-1360-yCrossref (19) A systematic review relationship acute late toxicity radiotherapy found morbidity statistically causally linked [[9]Peach M.S. Showalter T.N. Ohri Systematic gastrointestinal cancer.Prostate Cancer. (https://dx.doi.org/10.1155%2F2015%2F624736): 624736PubMed If too soon resulting worsening toxicity, therefore increase morbidity, such chronic bleeding. To develop guidance how long should abstain receiving before, modified Delphi technique using two question rounds was used generate consensus opinion panel 15 clinical oncologists 11 urological surgeons. Panel members were recruited assistance Royal College Radiologists, British Association Urological Surgeons, Uro-Oncology Group, LGBTQ+ Doctors Dentists, UK. study received ethical approval University Manchester (UREC 2017-1550-2673). pragmatic reasons, limited rounds, without initial open round, predefined level not set. Consensus defined median answer given listed Table 1. agreed sex, average agreement across 83%, clear could reached several relation abstain. example, 73% immediately external beam allow time radiation proctitis subside. only 27% 2 months radiotherapy. Similarly, 91% radical prostatectomy enable vesicourethral anastomosis heal, reducing leakage anastomosis, urinary incontinence perforation. 45% 6 weeks prostatectomy. Despite low interventions, mean timeframes do differ greatly median.Table 1Summary examples rationale provided membersInterventionAbstain (yes)Consensus∗Consensus timeframe each intervention. When member answered numerical transferred into statistical software 0 purpose calculating unsure if abstain, data included intervention, implied. (median)Consensus levelMeanExamples membersBefore PSA test-1 week58% (15/26)1.6 weeks‘Increases compression usually mild half-life 2.2 days week near normal levels return.’‘Prostate massage known levels. ensure accurate measurement, any form massage, including avoided before test.’After transrectal biopsy91% (10/11)2 weeks55% (6/11)1.5 weeks‘Needle punctures rectum heal trauma intercourse.’‘The delay ultrasound epithelium infection.’After tranperineal biopsy73% (8/11)1 week60% (6/10)1.2 weeks‘The been perforated ultrasound-guided biopsies, which case transperineal biopsies. Consequently, bacterial translocation about biopsies much less.’‘After biopsy skin wounds bruising settle reduce painful intercourse.’After prostatectomy91% (10/11)6 weeks45% (5/11)4.8 wall thinned Allowing healing oedema surgery basis my answer.’‘Complete must occur. Disruption major risk. Healing vital. Also, continence complication exacerbated.’After insertion fiducial markers60% (9/15)1 week40% (4/10)1.6 weeks‘Allow infection; early fibrotic reaction around markers stage. Also depends route insertion; transperineal, less.’2 weeks40% (4/10)‘Fiducials need embed prostatic tissue consistent manner prior planning. They displaced intercourse. Loss make subsequent image-guided difficult/impossible. Ultimately intensity-modulated contribute so worth this investment part patient.’During radiotherapy73% (11/15)N/A73% (11/15)N/AN/AAfter (11/15)2 months27% (4/15)1.9 months‘Any post-radiotherapy avoided. Typical recovery weeks, seems reasonable.’‘The often develops degree (even subclinical) meaning prone damage, term. Thus, I think intercourse probably best-avoided radiotherapy.’After high-dose rate brachytherapy100% (5/5)2 months60% (3/5)1.6 months‘To decrease anorectal symptoms.’‘To inflammation settle.’After permanent seed brachytherapy (iodine-125)100% (4/4)1 month50% (2/4)1.5 months‘Radiation exposure partner local settle.’2 months50% (2/4)‘Radiation protection issues.’PSA, prostate-specific antigen.∗ Open table new tab PSA, antigen. failed reach iodine-125 brachytherapy. Given similarities sensible mirror advice produced depending what inserted. consultation medical physics experts, recommended measure minimise partner's sex. Medical physicists produce individualised assessments, period individual patient advised comparison generic (the process followed Appendix A). avoid false-positive antigen (PSA) test; post-intervention complications; manage appropriately; partners. study, asked practice communication. agreeing 39% said ask orientation. Furthermore, 13% aware bisexual. recent survey oncologists, 5% patient's orientation just 8% felt confident knowledge specific healthcare patients [[10]Berner A.M. Hughes D.J. Tharmalingam H. Baker T. Heyworth B. Banerjee al.An evaluation self-perceived knowledge, attitudes behaviours cancer.ESMO Open. 5e000906https://doi.org/10.1136/esmoopen-2020-000906Abstract (6) initiatives NHS Rainbow Badge Project [[11]Stonewall. NHSRainbow badges.2021https://www.stonewall.org.uk/about-us/news/nhs-rainbow-badges-%E2%80%93-play-your-part-promoting-lgbt-inclusion-healthcareDate Scholar], aims environments inclusive patients, these statistics show services quite far down equality diversity yellow brick road be. prevent becoming box ticking exercise, incumbent upon professionals responsibility making own inclusive. age 65–69 years [[12]Prostate Are you risk?.2019https://prostatecanceruk.org/prostate-information/are-you-at-riskDate man lived when criminalised classified mental illness. through HIV/AIDS crisis 1980s, attached further stigma shame practices. Many had negative experiences because Older unlikely forthcoming fear actual perceived discrimination [[13]Hoyt Frost D.M. Cohn Millar B.M. Diefenbach Revenson T.A. Gay men’s implications future research.J Health Psychol. 3 (https://doi.org/10.1177%2F1359105317711491): 298-310Google initiating conversations. previous editorial Clinical Oncology contains useful ‘practice pointers’ approach conversations [[14]Berner Webster R. Saunders Education improve care UK.Clin Oncol. 33: 270-273https://doi.org/10.1016/j.clon.2020.12.012Abstract (1) help facilitate disclosure within setting, added Sexual Inventory (SHIM), complete consultation. discussing overly language feel awkward, asking someone blunt. It helpful incorporate would use themselves describe ‘top’ takes ‘bottom’ ‘versatile’ enjoys both. terminology universally community, particularly Western societies. discloses then ask, ‘In your life, following, words enjoy: top, bottom versatile?’ pride providing person-centred holistic care. sometimes fall short standard failing recognise relevance fulfil basic tenets, endeavour charities, UK, taken leading addressing concerns development targeted information support resources [[15]Prostate StonewallExploring cancer.2013https://www.patientlibrary.net/cgi-bin/download/file/122053Date Scholar,[16]Prostate tests guide men.2018https://shop.prostatecanceruk.org//our-publications/all-publications/prostate-cancer-tests-and-treatment-guide-for-gay-and-bisexual-menDate May charity played instrumental setting up continued Out LGBT Walnut, UK's groups trans women. lot excellent work done National Service inequalities organisation still go catch positive set national charities. consent General Council, supporting law, advises rely assumptions might want need, significance attach different outcomes [[17]Chan S.W. Tulloch Cooper E.S. Smith Wojcik Montgomery informed consent: where we now?.BMJ. 357: j2224https://doi.org/10.1136/bmj.j2224Crossref (137) described literature ‘invisible diversity’ [[18]Blank T.O. invisible diversity.J Clin 2005; 23: 2593-2596https://doi.org/10.1200/jco.2005.00.968Crossref (0) ‘hidden populations’ [[19]Filiault S.M. Drummond M.J.N. J.A. voicing hidden population.J Men’s 2008; 5: 327-332https://doi.org/10.1016/j.jomh.2008.08.005Abstract (53) Scholar] ‘a truly species’ [[20]Perlman Drescher Introduction: (and dear them) know cancer.J Lesbian Psychother. 9: 1-7https://doi.org/10.1300/J236v09n01_01Crossref (7) visible, move away heteronormative model care, assumed unless self-disclose otherwise. initiate practices, undergoing receive tailored information, empowering them decisions appropriately. Ralph reports financial Institute Research . Co-founder Cancer, first group women, established 2013.