Body image and self esteem following a prostate cancer diagnosis: perspectives according to sexual orientation

Gay men diagnosed with prostate cancer are not a readily identifiable group. This thesis is designed to explore the proposition that gay and straight men might experience the psychosocial aspects of prostate cancer differently. Positioned in a theoretical framework of health-related stigma, it was designed to investigate the ways in which the burden of diagnosis and treatment of prostate cancer are experienced by gay men. To explore this, three studies of different methodology were used: a systematic review to find published literature concerning the quality of life of gay men diagnosed with prostate cancer, an online focus group for gay men to determine the needs and challenges of gay men diagnosed with prostate cancer, and an online survey to compare body image, self-esteem, urinary function and sexual function in gay and straight populations with and without a diagnosis of prostate cancer. Four papers fulfilled the criteria for inclusion in the systematic review, which showed that sexual orientation impacts the quality of life of gay men in a unique way. Focus group results identified several factors (such as the emotional response to a prostate cancer diagnosis, access to help and support, and the impact of sexual changes on identity) which, because of resulting stigma, affect the ability to improve quality of care. Counter-intuitively, the internet survey findings showed no significant differences between gay and straight men with prostate cancer in measures of body image, self-esteem, sexual function or urinary function, but did show differences in men with a diagnosis of prostate cancer compared to those without, regardless of sexual orientation. Prostate cancer appears to affect the quality of life of gay men in unique ways, affecting their ability to maximise quality of care because of associated stigma.Submission note: A thesis submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy to the Graduate Research School, La Trobe University, Bundoora