Gay and bisexual prostate cancer patients should wait up to six months after treatment until they receive anal sex again, new guidelines say.
A group of surgeons who issued the recommendation said having sex too soon after a major operation risks bleeding, infections and pain.
Currently, many gay and bisexual prostate cancer patients are walking away without any advice because doctors don’t ask about their sexual orientation.
But gay or bisexual men receiving anal sex are at risk of physical damage in the weeks following their treatment.
Those who have radiation treatment should wait the longest – six months – to avoid harming themselves or their partners.
Gay prostate cancer patients should wait up to six weeks or more until they have anal sex again to avoid the risk of bleeding, infections and pain, top surgeons have said (stock image)
The first-of-its-kind guidance is based on the opinions of 15 cancer doctors and 11 surgeons across the UK.
Sean Ralph, a radiographer from the Clatterbridge Cancer Centre NHS Trust near Liverpool, was part of the team who drew up the guidelines.
He said: ‘We found that most oncologists and surgeons don’t ask patients about their sexual orientation or sexual practices.’
Mr Ralph said this ‘means some men won’t get the appropriate advice and support they need to continue having a safe and fulfilling sex life’.
He added men are normally advised to start having sex again soon after prostate cancer treatments in order to help preserve their erectile function.
Some treatments for prostate cancer can damage the nerves and blood vessels that are needed for an erection.
‘However, the increased likelihood of participating in anal sex means that some groups of patients – gay and bisexual men in particular – have different risks, such as the possibility of anal sex causing physical damage after a prostate operation or radiotherapy,’ Mr Ralph said.
The team came to the conclusion that following surgery to remove the prostate – a radical prostatectomy – sex should be avoided for six weeks.
After external beam radiotherapy, patients should avoid sex for two months to reduce the risks of pain or long-term complications such as rectal bleeding, the guidance said.
WHAT ARE THE GUIDELINES’ WAITING TIMES?
According to guidelines put together by doctors and surgeons, men being tested or treated for prostate cancer should leave the following time gaps from receiving anal sex to avoid internal injuries, incorrect test results or damage to their partner:
- One week before a prostate-specific antigen (PSA) blood test
- One week after a biopsy using a needle through the perineum (between the scrotum and anus)
- Two weeks after a biopsy using a needle through the rectum
- Six weeks after surgery to remove the prostate (radical prostatectomy)
- Two months after external beam radiotherapy
- Six months after permanent seed brachytherapy
And men who have permanent seed brachytherapy, in which lumps of radioactive material are left inside the body to destroy the cancer, should wait six months or more.
Their sexual partners could be exposed to damaging radiation if they start having sex again too soon, the experts said.
And before a PSA test, which is a blood test that can help diagnose prostate cancer, sex could skew the results and should therefore be avoided for a week before.
This is the first time health professionals have come together to develop clinical advice in relation to anal sex and prostate cancer.
The panel themselves admitted they did not always ask prostate cancer patients about their sex lives.
Only three out of the 26 (12 per cent) said they always asked prostate cancer patients about their sexual orientation.
And only two of the 26 (eight per cent) always ask about anal sex if they are aware their patient is gay or bisexual.
Dr John Burton, from Edinburgh Cancer Centre, said: ‘This guidance will be invaluable to clinicians and people receiving treatment for prostate cancer.
‘It is long overdue, and addresses an inequality in the level of information available to patients.
‘This will not just benefit patient care in the UK, but as the first guidance of its kind in the world, it will inevitably have an impact across the cancer community globally.’
Mr Ralph said making the guidance was difficult because there is a lack of concrete clinical evidence on the subject. The figures are based on the most common answers provided from top clinicians.
Prostate Cancer UK has already incorporated these findings into its patient advice.
Catherine Winsor, spokeswoman for the charity, said its specialist nurses often get asked about the issue from patients and professionals.
She said: ‘This important and much-needed research has addressed an important gap in our ability to support gay and bisexual men.
‘We hope that health professionals will use these findings to provide more consistent, evidence-based guidance to men who have anal sex.’
Prostate cancer is the most common cancer in men, affecting one in eight men in the UK.
Around 47,000 men are diagnosed with prostate cancer every year in the UK, and 174,650 men in the US.
The guidance will be presented at the UK Imaging and Oncology congress in Liverpool.
WHAT IS PROSTATE CANCER?
How many people does it kill?
Prostate cancer became a bigger killer than breast cancer for the first time, official statistics revealed last year.
More than 11,800 men a year – or one every 45 minutes – are now killed by the disease in Britain, compared with about 11,400 women dying of breast cancer.
It means prostate cancer is behind only lung and bowel in terms of how many people it kills in Britain. In the US, the disease kills 26,000 each year.
Despite this, it receives less than half the research funding of breast cancer – while treatments for the disease are trailing at least a decade behind.
How quickly does it develop?
Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS.
If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted.
Some patients can be cured if the disease is treated in the early stages.
But if it diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.
Thousands of men are put off seeking a diagnosis because of the known side effects from treatment, including erectile dysfunction.
Tests and treatment
Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge.
There is no national prostate screening programme as for years the tests have been too inaccurate.
Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.
Men over 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.
But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not foolproof.
Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks.
Anyone with any concerns can speak to Prostate Cancer UK’s specialist nurses on 0800 074 8383 or visit prostatecanceruk.org