Sexual Health Outcomes in Sexual Minority and Heterosexual Men After Prostate Radiation Therapy

Purpose/Objectives: To characterize the effects of prostate radiation therapy on sexual health outcomes in sexual minority men (SMM), particularly those engaging in receptive anal intercourse (RAI), and compare them with heterosexual men (HET). Methods and Materials: This retrospective cohort study included patients with intact prostates, ≥6 months after radiation therapy and androgen deprivation therapy (ADT), seen between June 2022 and August 2023, and sexually active with a partner in the prior 30 days. Patients self-reported sexual orientation, gender identity, sexual behaviors, and health outcomes using select items from Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, Sexual Health Inventory for Men, and American Urological Association questionnaires. P values <.05 were considered statistically significant; mean differences (MD) ≥3 were considered clinically meaningful. Results: Of eligible participants, 39% HET (n = 57/145) and 68% SMM (n = 21/31) were sexually active with a partner in the last 30 days (P = .005); including 15 (71%) SMM engaging in RAI. Overall, 9% received brachytherapy, 46% external beam radiation therapy, 45% both; 14% received ADT. The cohort reported worse orgasm ability (3.3, P < .01), orgasm pleasure (MD: 7.2, P < .001), and sexual satisfaction (MD: 3.4, P < .001) compared with US general population normative scores for sexually active adult men. SMM were more likely to be single (72% vs 33%, P < .001) and have higher prostate-specific antigen at diagnosis than HET (P = .031). SMM engaging in RAI reported worse orgasm ability (MD: 3.5), orgasm pleasure (MD: 6.3, P < .05), and anal discomfort (MD: 9.0) compared with norms. For SMM engaging in RAI, brachytherapy with/without external beam radiation therapy was associated with worse orgasm pleasure (MD: 3.1), yet less anal pain (MD: 5.2) compared with external beam radiation therapy alone; the addition of ADT was associated with worse orgasm ability (MD: 14.1, P < .05), orgasm pleasure (MD: 10.7, P < .05), anal pain (MD: 6.8), and sexual satisfaction (MD: 6.1). Conclusions: Prostate cancer treatments uniquely affect sexual health in SMM, particularly those engaging in RAI. Clinicians should inquire about sexual orientation, gender identity, and sexual behaviors when discussing treatments to align care with individual preferences.