First Clinical Guidance to Address Anal Intercourse After Prostate Cancer

The guideline is
being presented at the UK Imaging and Oncology Congress 2019 (UKIO19) between
10-12 June, 2019 at the ACC Convention Center, King’s Dock, Liverpool, UK. This
congress is the largest imaging and oncology event in the UK.

No guidelines
currently exist for advising gay and bisexual men who practice anal intercourse
in conjunction with

. Men are usually advised to
resume sexual activities after prostate cancer treatment as its help to
maintain normal erectile function. However, gay and bisexual men, who participate
in anal intercourse could be at a higher risk of physical damage, following
prostate surgery or radiotherapy. Moreover, doctors generally don’t ask men
about their sexual orientation or sexual practices, thus depriving them of
useful advice and support for practicing safe sex. The importance of
the new guideline lies in the fact that it presents clear-cut recommendations
for men having anal

before, during, and after diagnosis
and treatment of prostate cancer.

The guideline is based on the consensus
opinion of 11 urological surgeons and 15 clinical oncologists who were
recommended by the Royal College of Radiologists, Prostate Cancer UK, the
British Uro-oncology Group, the Gay and Lesbian Association of Doctors and
Dentists, and the British Association of Urological Surgeons.


The guideline
coordinator was Sean Ralph, who is a therapeutic radiographer at the
Clatterbridge Cancer Center NHS Foundation Trust, Birkenhead, Wirral, UK. He is
also the Co-Founder of ‘Out with Prostate Cancer’, which is the first prostate
cancer support group in the UK exclusively for gay and bisexual men.

Key Recommendations of the Guideline

The recommendations
by the doctor’s panel on the safety of anal intercourse before, during and
after prostate cancer diagnosis and treatment are highlighted below:

Investigation / Intervention

Timeframe

Expert Opinion

Prior to prostate-specific antigen (PSA) test

1 week

May lead to an inaccurate result

After transrectal ultrasound scan (TRUS)

2 weeks

May cause pain, bleeding and increased risk of infections

After transperineal biopsy

1 week

Will allow bruising to resolve and reduce painful intercourse

After radical prostatectomy

6 weeks

May cause pain, bleeding and increased risk of urinary incontinence

After external beam radiotherapy

8 weeks

Acute side effects could become worse, causing pain and chronic rectal bleeding

After permanent seed brachytherapy

6 months

Will reduce risk of radiation exposure to sex partner

How
was the Consensus Reached while Formulating the Recommendations?

The recommendations on how long men should abstain
from anal intercourse following prostate cancer diagnosis and treatment varied
widely. The consensus was reached by taking into consideration the common
opinions, as there is no clear clinical evidence available on the topic. The
opinions of the highly experienced prostate cancer specialists enabled
formulation of the guideline, which is the first of its kind. Importantly, this
guideline will help to inform both
doctors and patients about best practices, based on clinical experience and
judgment.

The guideline has
already been put into practice by Prostate Cancer UK for treating prostate
cancer patients.

Doctors in the Panel didn’t Practice what
they Preached – An Eye Opener!

Despite the fact
that all the panelists agreed that it was important to abstain from anal
intercourse following prostate cancer, very few of them followed these
recommendations, as revealed by the following figures:

  • 3 of 26 panelists (12%) asked patients about their sexual orientation and
    sexual practices
  • 2 of 26 panelists (8%) asked patients about anal intercourse, if they
    were aware that the patient was gay or bisexual

In this regard, David Ralph said: “Prostate
cancer should be viewed as a disease which affects sexual health, wellbeing,
and relationships. Health professionals should therefore be asking men
questions about their sexual orientation and sexual practices in order to
ensure that they have the right information to make informed treatment
decisions and to manage their side effects appropriately.”
He added: “Patients should be cared for in a manner
that takes account of their needs as an individual, including their sexual
orientation. Patient-centered care needs to be truly incorporated into the
training of health professionals and the culture of the NHS and not just used
as the latest buzzword as part of some target driven, box
-ticking
exercise.”

Expert Comments

Dr. John Burton,
Principal Radiographer, Pre-Treatment, Radiotherapy at Edinburgh Cancer Center
and UKIO Vice-President, Oncology, expressed his opinion in an independent
capacity as he was not involved in the development of the guideline. He said: “This guidance will be invaluable to clinicians and people
receiving treatment for prostate cancer. It is long overdue, and addresses
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. More generally, this work is about not making assumptions but instead
listening to the patient and providing them with advice appropriate to their
situation; this is something we need to remember with every patient.”

Catherine Winsor, who is Deputy Director of Support
and Influencing at Prostate Cancer UK said: “Our specialist nurses often get
asked how long men should abstain from having
intercourse before, during and
after different tests and treatments for prostate cancer, from both patients
and the professionals who support them. This important and much-needed research
has addressed an important gap in our ability to support gay and bisexual men.
She added: We’ve
used this to update our written patient information for this group to include
these more specific timeframes on when they should abstain. We hope that health
professionals will use these findings to provide more consistent,
evidence-based guidance to men who have anal intercourse .”

Funding Source

The development of the guidance document was
funded by Health Education England (HEE) and the National
Institute for Health Research (NIHR), UK.

Source: Medindia