||5R01CA218657-02 Interpret this number
||Rosser, B R Simon
||University Of Minnesota
||RESTORE: Improving Sexual Outcomes of Gay and Bisexual Prostate Cancer Survivors
Abstract: This application, in response to PA-15-261, “Research leading to interventions to ameliorate health
disparities of sexual and gender minorities”, advances research in three areas. First, prostate cancer (PCa) is
the second most common cancer among gay, bisexual, and other men who have sex with men (GBM), with
documented disparities, yet it is severely under-researched. Because gay sex differs from vaginal sex,
physiologically; the results from 614 studies focused on heterosexual men likely do not generalize to GBM with
PCa. There have been no rehabilitation studies specific to GBM survivors of PCa, so clinicians have no
relevant studies to inform best practice with their GBM patients. Second, most PCa studies have tested one or
rehabilitation components. We will conduct the first treatment study of a state of clinical practice
comprehensive rehabilitation program on GBM's quality of life, including on both urinary and sexual function
and bother measures. Third, almost all PCa studies have focused on men recently treated for PCa. We will
study both GBM recently treated (last 2 years) and GBM post-treatment (2+ years), using a stratified design.
This study builds on our findings in Restore, an R21 which was only the second study of GBM with PCa to
be funded by NCI, and the first to reach publication. We conducted N=41 in-depth qualitative interviews with
good saturation, and the largest quantitative study of GBM with PCa to date (N=193), the first needs
assessment of GBM with PCa, and the first study of same sex partners and care-givers of GBM. Participants
described radical prostatectomy as leaving them “humiliated,” “maimed”, “less than other gay men,” and
“severely depressed.” Most (88%) reported ongoing sexual challenges contributing to decreased quality of life,
poorer mental health, identity challenges and deteriorated primary relationships. Only three of the eight (38%)
outcomes commonly experienced by most GBM were discussed as part of treatment. There was no evidence
of any standard of professional rehabilitation; indeed, most GBM just treated themselves.
The long-term objective of this research is to improve the health of GBM survivors of PCa and to provide an
evidence base for rehabilitation. In Aim I, we will develop an online rehabilitation program tailored for GBM that
addresses both the sexual and urinary effects of PCa treatment. In Aim II, we will conduct a comparative
recruitment study to identify best methods to recruit 450 GBM with PCa. In Aim III, we will evaluate the effects
of the tailored rehabilitation program on sexual and urinary outcomes. We will conduct a 24 month, randomized
controlled trial of structured rehabilitation versus routine care. This RCT will identify whether a structured
rehabilitation program is effective in addressing the major sexual and urinary problems caused by PCa
treatment. As the first treatment study to focus on GBM with PCa (and also on oral and anal sex), it addresses
a long-standing health disparity. The study has high potential to transform rehabilitation for GBM with PCa,
provide a critical evidence base for clinicians, and inform rehabilitation outcomes for all PCa survivors.
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