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Prostate Cancer, Anal Sex And You: Two Seperate Yet Intertwined Issues For Gay Men and MSMs

This article is written in the attempt to dispel the popular myth that anal sex can be a cause of prostate cancer. Prostate cancer, like any other cancers such as lung, colon, skin, anal and testicular, does not discriminate, and can affect men from all walks of life.

Anal sex does not cause prostate cancer, nor will it cause it to come back.

prostate1.jpgWith recent broadcasts surrounding prostate cancer on the local news, (and from another personal experience of an MSM acquaintance who just had the cancer removed), I think it will be a good idea to provide some key information regarding this issue. Moreover, it is also Project X’s intention to start including more information on general men’s health issues that may directly or indirectly affect their sexual health.

Prostate cancer is one of the most common, yet least talked about, forms of cancer occurring in men. Prostate Cancer is the only one of the four disorders is potentially life-threatening. One of the most worrying aspects is that many prostate cancers develop without men experiencing ANY SYMPTOMS.


Prostate cancer and Australian men

Every year, around 12,000 Australian men are diagnosed and more than 2,700 die of the disease, making prostate cancer the second largest cause of male cancer deaths, after lung cancer. Almost one man in eleven will develop prostate cancer during his lifetime.

Prostate cancer occurs when some of the cells of the prostate reproduce far more rapidly than in a normal prostate, causing a swelling or tumour. However, unlike BPH, prostate cancer cells eventually break out of the prostate and invade distant parts of the body, particularly the bones and lymph nodes, producing secondary tumours, a process known as metastasis. Once the cancer escapes from the prostate, treatment is possible but &ldquocure&rdquo becomes impossible.

Prostate cancer is usually one of the slower growing cancers. In the past, it was most frequently encountered in men over 70, and many of those men died of other causes before their prostate cancer could kill them. This led to the old saying &ldquomost men die with, not of, prostate cancer&rdquo. However, that is certainly is not true today. Three developments have changed things considerably:

  • Men are living longer, giving the cancer more time to spread beyond the prostate, with potentially fatal consequences.
  • More men in their early sixties, fifties and even forties are being detected with prostate cancer. Earlier on-set, combined with the greater male life expectancy, means those cancers have more time to spread and become life-threatening unless diagnosed and treated.
  • Prostate cancer in younger men often tends to be more aggressive and hence more life-threatening within a shorter time.

Provided appropriate treatment commences while the cancer is still confined to the prostate gland, it is possible to "cure" it. The possibility of cure is the main reason why early diagnosis is critical

What is it?

The walnut-sized prostate gland is located in front of the rectum and below the bladder. Its main job is to produce the fluid that nourishes and protects sperm cells. 

 (scroll over image to veiw the prostate. Image taken from http://www.prostate.org.au/what-is-the-prostate.php)
anatomy.jpg 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The most common form of prostate cancer develops in the glandular cells. While most prostate cancers grow very slowly, if it's an aggressive form, it can quickly spread to the area surrounding the prostate, and eventually metastasize to the lymph nodes, lungs, liver, and other parts of the body.


What is it about the prostate that causes so much pleasure with anal sex?

The prostate is a very sensitive gland or organ that resides between the rectum and the bladder. There are nerve endings in the prostate which connect to the base of the spinal cord and directly to the brain. Stimulation of the prostate with a finger, dildo, penis or other sex toy can be very pleasurable. The use of adequate water-based lubrication and a condom on an erect penis can increase the pleasure to the receptive partner.

Who is at risk?

Your chances of developing prostate cancer have a lot to do with factors you can't control, like age and family history. Some doctors believe that having a vasectomy can also increase the risk, but the medical community is divided on the issue.

Some of the known risk factors include:

  • Age: The risk of prostate cancer increases as you get older. All men should be aware of their risk of the disease and consider being tested for it regularly from age 50 onwards, or from 40 onwards if there is a family history of prostate cancer.
  • Race: The reason is a mystery, but prostate cancer is more likely to occur in Afro-American and Hispanic men, who are more than twice as likely to die of the disease than their Anglo-Saxon counterparts. The occurrence of the cancer is lower in Asian men.
  • Family history: Having an immediate family member who has suffered from prostate cancer more than doubles your risk of eventually contracting it.
  • Diet: Eating an abundance of red meat and high-fat dairy products may increase your risk of prostate cancer.

Some doctors think that a condition known as prostatic intraepithelial neoplasia, or PIN, can be an important indicator of whether or not you will develop prostate cancer. PIN refers to tiny changes in the size and shape of prostate gland cells, and can appear in men as young as 20. A high-grade PIN on a prostate biopsy may or may not indicate the presence of cancer, but your doctor will definitely want to keep regular tabs on your prostate if a high number is discovered.


What are the common reasons to get tested?


Most men will seek testing for prostate cancer for the following reasons:

  • As part of a general check up - usually after 50 years of age
  • Due to a recent experience with a relative or friend who has suffered from prostate cancer
  • A family history of prostate cancer
  • A recent onset of urinary symptoms


Speak with your doctor and make up your own mind in regards to testing.

Some men, when enquiring about prostate cancer, may be confused by conflicting views expressed about methods of diagnosing and treating the disease. Perhaps the most controversial is the view - which PCFA disputes absolutely - that it would be better for men not to know whether they have the disease and therefore they should not be tested be treated.

The thinking behind this is:

  • because the disease can be relatively slow to develop, most men would die with, rather than of, the disease.
  • because treatment has potentially serious side effects such as impotence and incontinence, treatment may be worse than the disease

All men have the right to make decisions for themselves about whether to be tested. It is your choice.

What are the symptoms?

Many cases of prostate cancer are slow-growing and symptom-free. That said, some men do experience symptoms like difficulty urinating, a weaker urine stream, pain or burning while urinating or ejaculating, dribbling after urination, and stubborn hip or back pain. If you experience any of these symptoms, it's important to see your doctor immediately.

How is it detected?

If you're in a high-risk category, regular screening can help spot the cancer early on. Prostate cancer can be found in two ways: A doctor can test the amount of prostate-specific antigen (PSA) in your blood or conduct a digital rectal exam.

A digital rectal exam is pretty much what it sounds like. The doctor inserts a finger into your rectum to manually check for any irregularities on your prostate. If the thought makes you squirm, you may want to realign your priorities: Regular tests can help catch prostate cancer at an earlier, less hazardous stage and increase the odds of eliminating the disease.

If prostate cancer is suspected, your doctor will likely want to schedule a blood test to determine the amount of PSA in your blood, as well as conduct a biopsy.  A prostate biopsy is usually performed by a urologist, who removes samples of tissue from your prostate with a needle and the visual help of a transrectal ultrasound.

If cancer is detected, it must then be graded. Grades are assigned to the two areas of the prostate that contain most of the cancerous cells and are added together to obtain a Gleason score. The higher the score, the more aggressive the cancer could be.

How is it treated?

There are several treatment options with which to combat prostate cancer, but some men with the slow-growing variety choose no treatment at all. The term &ldquowatchful waiting&rdquo describes the decision to forgo treatment, but still keep tabs on the cancer.

This route is sometimes chosen by older men for whom the treatment&rsquos side effects represent more of a health risk than the cancer itself or by men who don&rsquot want to deal with the possible side effects of treatment. Often, men with slow-growing prostate cancer have about the same life expectancy as those without cancer.

If you decide to pursue treatment, you have several options:

  • Radical prostatectomy: Removal of the prostate gland can be a very effective treatment option, but having to recuperate for weeks and endure possible side effects like incontinence and impotence causes many men to shy away from it.
  • Radiation: It can be just as effective as RP and the recovery time is shorter, but radiation treatment is also linked to impotence.
  • Hormone therapy: Lowering testosterone levels can slow the progression of some forms of prostate cancer and help manage aggressive forms of the disease.
  • Chemotherapy: Chemotherapy drugs are often used to treat men with advanced prostate cancer.
  • Cryotherapy: It's a relatively new treatment with a space-age name, but cryotherapy actually consists in freezing -- and hopefully destroying -- cancerous cells.
  •  High Intensity Focused Ultrasound (HIFU): The opposite of cryotherapy, HIFU uses a high-intensity ultrasound beam to heat the cancerous prostate cells until they die.

Prevention is key

The same mantra you hear about many cancers also applies to prostate cancer: Early detection can play a key role in its control and elimination. That's why it's important not to let your squeamishness get the best of you; relax and get the test over with. Regular prostate exams, along with knowing the steps you can take to prevent this disease, will go a long way in keeping your prostate health on the right track.


Is there sex after prostate cancer?

Although the diagnosis of prostate cancer is devastating, the disease is highly treatable. Treatment, however, does have side effects that can drastically affect sexual function&mdashboth from a physiologic and psychological standpoint.
Younger men, men with less extensive prostate cancer and those who have had an active sex life before developing prostate cancer are less likely to experience difficulties with sexual function after cancer treatment. Communication between sexual partners and physicians is also crucial for dealing with alterations of sexual function. Sex with another man did not cause the prostate cancer and it will not cause it to return.

&ldquoWill I have sex again?&rdquo is not an easy question for a doctor to answer because it depends on a multitude of factors. Hopefully one&rsquos doctor will have raised the issue before treatment&mdasheven if the patient did not. But still, discussing sex with one&rsquos doctor early on may not offer much solace when trying to &lsquoget it up&rdquo that first time after treatment for prostate cancer has occurred.

Treatment for prostate cancer affects sexual function for two important reasons: The prostate contributes the bulk of the fluid that makes up semen; so depending on which of the two major treatments for prostate cancer a man chooses, he may discovered that he has little to no ejaculate at all after treatment. Second, the nerves that stimulate the penis to become erect run close-by the prostate gland. They too can be affected by cancer treatment. In addition, anal sex, which may be an integral part of a gay man&rsquos sex life, may also be affected by certain treatments for prostate cancer. Sexual function can depend greatly whether or not the treatment was surgery or radiation therapy. It is best to discuss the various issues specific to each treatment.


Radical Prostatectomy

Surgical treatment for prostate cancer is called a &lsquoradical prostatectomy.&rdquo The surgery removes the entire prostate gland and some surrounding tissue. The doctor tries to spare the nerves that stimulate an erection, but sometimes nerve injury cannot be avoided as the surgeon tries primarily to cure the cancer (Jelsing, 1999). Most men notice significant change in erections even after what is called &ldquonerve sparring&rdquo surgery. It can take as long as two years for erections to stabilize.


Inability to ejaculate

The other universal complication after radical prostatectomy is failure to ejaculate. When the surgeon removes a man&rsquos prostate, the muscle that closes his bladder allowing his ejaculate to move out of the penis rather than back into his bladder is destroyed. Instead of shooting out, his ejaculation becomes &ldquoretrograde&rdquo and shoots into his bladder. While still perfectly capable of having an orgasm, no ejaculate comes out. This can be a very troubling complication of surgery for some men and their sexual partners. Some men feel that they are not really sexually satisfied if nothing comes out. They may also feel less manly. Semen itself is erotic for many gay men. They like to see it, feel it and taste it. Retrograde ejaculation can rob them of this very important stimulant. Fortunately, radical prostate surgery does not affect the anus or rectum. Once the patient gets over the pain from surgery and the incision fully heals, he will be able to have anal sex again without restriction. Anal sex did not cause the prostate cancer not will it cause it to come back.

If you have any queries, please consult your local GP.

Medical information are excerpted from A Gay Man's Guide to Prostate Cancer edited by Gerald Perlman, PhD and Jack Drescher, MD (Haworth Press)  and Gayhealth.com (no longer in operation) see shoutouthealth.com and Prostate Cancer Foundation of Australia (PCFA)

 
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