Many doctors say, “I treat all patients the same.” But not all patients are the same. Married and single patients have different treatment goals and expectations. Younger and older prostate cancer patients have different ways to digest their diagnosis. And, men who have sex with men have different concerns, too.
Hearing a prostate cancer diagnosis revisits the coming out experience.
Coming out as a gay man is often an isolating experience, and is echoed by hearing that he is diagnosed with cancer.
It is hard for a man to come out as a gay or bisexual man, now he is faced with coming out as a cancer survivor….even harder when your social community is so deeply invested in supporting other issues such as HIV/aids and Don’t Ask, Don’t Tell.
Many gay men start have experienced their early lives in heterosexual relationships and marriages. They have tried hard not to be gay, and struggled to get past the fears and risks associated with being out. Now, they are trying hard to not be the person diagnosed with cancer, not the person whose life is once again at risk.
Patient needs assurance that his doctor respects him as a gay man. Simply by asking a man if he enjoys sex with men, women or both, sets a calm and understanding clinical relationship. The patient needs to hear his doctor ask questions to understand the patients concerns about treatment outcomes, such as sexual performance, and will take steps to protect him from all of his practical concerns, such as visitation rights.
Doctors should be prepared to respond to gay focused questions as well as clearly communicate a sense of comfort around sexuality. Being Gay is not the same as being short, tall or Russian. Learn basic “gay science,” such as what being a bottom versus top is all about, how some men enjoy prostate massage or play with ejaculate. Gay couples can present as mundane or inflamed as heterosexual couples; accept the idea that a gay marriage is dynamic and love filled. Children are important. Many gay couples have sons and daughters. Include them in consults in the same way you might discuss any other family members. Ask if your patient’s husband is also diagnosed or is concerned about prostate cancer. And sperm banking should always be discussed. Never assume that Gay men lack interest in fathering children. Take a few minutes to Google Gay history. Understand that ADT echoes in history as a punishment for gay men. Gay men sometimes struggle with externally induced self-blame for the problems of their own health. Assure men that their behavior is not responsible for their prostate cancer.
Men diagnosed with HIV/aids as young men, are now aging into the realm of prostate cancer diagnosis.
Get your nursing and office staff on board.
And, offer your patient the opportunity to speak with you, alone…even if he presents with his wife and declares him in a heterosexual marriage. Many men do not consider themselves gay, but they do enjoy sex with other men, often in secret. We all want our patients to feel comfortable reporting their symptoms from their own person context and set of goals. In 2010, in just about every part of the Earth, our gay patients face a special challenge in reporting their goals and symptoms. With very little preparation, we all can make our gay patients feel safe, listened to and well treated.
If you don’t think you have gay patients, you simply haven’t asked.