Dear Dr.Meyers,
I am 64 yrs old. PSA was 6.9 and Gleason score of 6. My urologist estimates stage T2a to T2c. My seminal fluid has lost most of the red tinge after the biopsy.
My question is somewhat delicate. I am a (passive) gay man living in a small town where it is not generally known that I am gay. I am reluctant to ask my urologist this question for privacy reasons:
I will be travelling to another town at New Year to stay with my partner. Do you think that it is inadvisable or possibly dangerous for me to receive anal penetration by a penis or dildo? My fear is that this mechanical intrusion might (7 weeks after the biopsy) stir up or injure the recently insulted rectum and/or prostate, and possibly cause malignant cells to spread out of the prostate into my general system. I am due to have a retropubic radical prostatectomy.
Also, do you think that leaving the operation for 3 months after the biopsy is a dangerously long time?
I will take the easy question first. Gleason 6 cancers move slowly. So, there should be no risk in waiting three months. The only caveat is that up to 30% of men with a Gleason 6 cancer will be found to have more extensive or more aggressive cancer at the time of surgery. Some of those with more aggressive disease can be identified based on how fast the PSA was increasing before surgery, but this is not a perfect tool as there are aggressive cancers that produce little PSA.
The second question on anal sex is hard to answer as the medical literature is silent on this subject. So, I will make my best guess on this matter. I will start by saying that anal sex practices do vary among homosexuals and can range from gentle to pretty traumatic. Obviously, I would recommend you avoid anything traumatic.
Gleason 6 cancers tend not to be invasive and are not usually thought of as spreading after prostate trauma or biopsy. The picture on more aggressive disease is less clear. However, most people in the field do not think that biopsy spreads even high-grade cancer. If a biopsy does not spread the disease, then I suspect that anal sex is not likely to be as traumatic as a biopsy.
The key experiment would be to measure circulating cancer cells after anal sex and I cannot find a paper on this subject.