title: Health-Related Quality of Life, Psychological Distress, and Sexual Changes Following Prostate Cancer: A Comparison of Gay and Bisexual Men with Heterosexual Men.
abstract: BACKGROUND
  Decrements in health-related quality of life (HRQOL) and sexual difficulties are a recognized consequence of prostate cancer (PCa) treatment. However little is known about the experience of gay and bisexual (GB) men.
  
  
  OBJECTIVE
  HRQOL and psychosexual predictors of HRQOL were examined in GB and heterosexual men with PCa to inform targeted health information and support.
  
  
  METHODS
  One hundred twenty-four GB and 225 heterosexual men with PCa completed a range of validated psychosexual instruments.
  
  
  METHODS
  Functional Assessment of Cancer Therapy-Prostate (FACT-P) was used to measure HRQOL, with validated psychosexual measures, and demographic and treatment variables used as predictors.
  
  
  RESULTS
  GB men were significantly younger (64.25 years) than heterosexual men (71.54 years), less likely to be in an ongoing relationship, and more likely to have casual sexual partners. Compared with age-matched population norms, participants in both groups reported significantly lower sexual functioning and HRQOL, increased psychological distress, disruptions to dyadic sexual communication, and lower masculine self-esteem, sexual confidence, and sexual intimacy. In comparison with heterosexual men, GB men reported significantly lower HRQOL (P = .046), masculine self-esteem (P < .001), and satisfaction with treatment (P = .013); higher psychological distress (P = .005), cancer related distress (P < .001) and ejaculatory concern (P < .001); and higher sexual functioning (P < .001) and sexual confidence (P = .001). In regression analysis, psychological distress, cancer-related distress, masculine self-esteem, and satisfaction with treatment were predictors of HRQOL for GB men (R2Adj = .804); psychological distress and sexual confidence were predictors for heterosexual men (R2Adj = .690).
  
  
  CONCLUSIONS
  These findings confirm differences between GB and heterosexual men in the impact of PCa on HRQOL across a range of domains, suggesting there is a need for GB targeted PCa information and support, to address the concerns of this "hidden population" in PCa care.
authors: Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia. Electronic address: j.ussher@uws.edu.au.
authors: Jane M
authors: JM
authors: Ussher
authors: Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors: Janette
authors: J
authors: Perz
authors: Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors: Andrew
authors: A
authors: Kellett
authors: Menzies Health Institute, Griffith University, Queensland, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP).
authors: Suzanne
authors: S
authors: Chambers
authors: Baylor College of Medicine, Houston, Texas, United States.
authors: David
authors: D
authors: Latini
authors: Monash University, Melbourne, Victoria, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP); Eastern Health, Melbourne, Victoria, Australia.
authors: Ian D
authors: ID
authors: Davis
authors: Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors: Duncan
authors: D
authors: Rose
authors: Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.
authors: Gary W
authors: GW
authors: Dowsett
authors: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP).
authors: Scott
authors: S
authors: Williams
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001727:Bisexuality / Q000523:psychology; D006304:Health Status; D020010:Heterosexuality / Q000523:psychology; D006716:Homosexuality / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life; D012649:Self Concept; D012725:Sexual Behavior / Q000523:psychology; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000523:psychology*; D012747:Sexual Partners / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D017741:Survivors / Q000523:psychology*
keywords: Erectile Dysfunction; Gay and Bisexual Men; Health-Related Quality of Life; Prostate Cancer; Psychosexual Predictors