Elton John’s Prostate Cancer: The Challenging Sexual Side Effects Even After An Excellent Prognosis

“I wasn't as shocked at hearing the word 'cancer' as I might have been. It was prostate cancer: no joke, but incredibly common. They'd caught it early, and besides, I'm blessed with a constitution that just makes me bounce back from illnesses,” John wrote in his upcoming memoir, which was excerpted in The Daily Mail.

John was right about how common prostate cancer is — he is one of 174,650 new cases of prostate cancer diagnosed each year, about 9.9 percent of all cancer diagnoses.

He’s also in the age range — men who are 65 and older — which makes prostate cancer even more common, according to the National Cancer Institute. It is the most common cancer other than skin cancer for men in America. Although most men who are diagnosed with prostate cancer do not die from it, it is the second highest cause of death behind lung cancer for men.

Fortunately, due to routine screening tests and effective treatments, prostate cancer has a 98 percent five year survival rate, meaning that people who are diagnosed usually live for at least five years after diagnosis.

Do gay or bisexual me have increase risk of prostate cancer and is prostate cancer different for gay men?

Literature on gay men and risk of prostate cancer is relatively limited, but there does seem to be evidence that gay men may experience more negative outcomes of treatment than straight men.

A 2016 study — which admittedly drew from a relatively small sample of literature — from researchers at the University of Minnesota says that gay and bisexual men and other men who have sex with men are diagnosed with prostate cancer at about the same rate as straight men, but have poorer sexual function and quality-of-life outcomes post treatment.

In a 2019 study also conducted by researchers at University of Minnesota, which surveyed 193 gay men after treatment for prostate cancer, two-thirds of participants described their sexual functioning, post-treatment, as fair to poor. Only 22% reported erections sufficient for insertive anal sex. For receptive anal sex, one-third reported pain.

Over half of the men in the survey reported urination problems during sex or at orgasm. Erectile difficulties were common, severe, and a reason cited for not using condoms.

How do I decide between surgery and radiation?

Elton John says in his new memoir that he opted for surgery to treat his prostate cancer because he wasn't at all keen on the other option which involved a rigorous course of radiation treatments.

Ten years after prostate cancer treatment, most patients have similar results whether they received radiation or surgery, according to Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center.

So deciding what treatment to go with is a very personal decision. Dr. Freedland says doctors will have their own bias regarding what they prefer, so it’s worth seeking out second and even third opinions before starting treatment.

When exactly should I get prostate cancer surgery?

There are differences of opinion when you’re considering treatment for early stage, high-risk prostate cancer. Some facilities believe surgery is the way to go as long as the disease has not spread.

Others feel the change in the quality of life has to be balanced against the potential that you’ve improved the overall outcome. “That’s a very serious conversation (patients) should have,” says Dr. Patrick Swift, Clinical Professor of Radiation Oncology at Stanford University Medical Center, “and it involves choosing between surgery or just having radiation with hormone therapy.”

What are the options for prostate cancer screening?

Elton John wrote in his memoir that, “They discovered [cancer] during a check-up…My doctor noticed the level of prostate- specific antigens in my blood had gone up slightly and sent me to an oncologist for a biopsy. It came back positive.” That makes John a great example of why it’s important to get screened for prostate cancer.

Current recommendations suggest that men begin speaking with their doctors about screening for prostate cancer at age 50, but there aren’t any specific guidelines about when to get screened because research hasn’t yet proven the advantaged outweigh the risks of screening.

Screening tests for prostate cancer include:

• Digital rectal exam, wherein a doctor or nurse inserts a gloved finger into the lower part of the rectum to feel for lumps on the prostate.
• Prostate specific antigen test (PSA), or a test that measures the level of PSA in the blood. PSA is a substance made mostly by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.
• Gene 3 (PCA3) RNA, which measures the amount of PCA3 RNA in the urine after a DRE. If PSA has been determined high, and a biopsy has shown no cancer, high amounts of PCA3 RNA may lead to another biopsy and may help diagnose prostate cancer
• Transrectal ultrasound, a procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate.

 

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