Matthew was diagnosed with cancer after a routine physical examination in October of 2019. The doctors told him that surgery to remove his prostrate was the best option.
Two years after the surgery, there is no indication that the cancer has returned. Mr. Curtin felt that many urologists were not equipped to deal with him because he was gay and the majority of doctors and their patients were not.
The same symptoms are found in all patients of the disease, including urinary incontinence, diminished libido, and loss of ejaculate. Gay and bisexual men may be affected by the changes in their lives in unexpected and difficult ways.
Patients relationships with their partners can be affected by the obstacles. They may pose a challenge to medical professionals who are more familiar with the needs of straight men.
The emotional and psychological effect that is not being treated is what struck Mr. Curtin when he was about three months into treatment.
Mr. Curtin said that his doctor first responded, "My office isn't prepared for this."
Mr. Curtin was looking for a different approach when he met Dr. Channa. The program is the first of its kind in the United States, and it is led by Dr. Amarasekera, who has focused his career on urologic care for gay and bisexual men and other sexual minorities.
The field of study is being driven by the increasing number of patients who identify as gay or bisexual. The medical system has been problematic because it has operated in a don't ask, don't tell environment. That is changing. Patients are more open about who they are.
The gay and bisexual men in their 50s and 60s who are now entering the prime demographic for prostrate cancer also lived through the worst of the AIDS epidemic. Many of them are more experienced in dealing with the medical establishment because of that experience.
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A patient with cancer is being scanned. The enlarged prostrate is visible in pink, and the cancer is on the prostrate.
Patients who came of age during that time should be reassured that things are different now and they can expect better care.
The research on gay and bisexual men and cancer is still woefully inadequate, according to experts in the field.
Simon Rosser, a professor of epidemiology and community health at the University of Minnesota, said that gay health research used to be focused on H.I.V. and young gay men.
As the AIDS generation grew older, specialists are starting to see gay patients. They haven't trained in sexual minorities or health care.
The chair of the urology department at the Feinberg School of Medicine at Northwestern University and the chief of urology at the hospital said he noticed the importance of a new approach about three years ago.
It was a big unmet need for Dr. Schaeffer, who has focused on the differences between Black men and other men with cancer. The program was created with Dr. Amarasekera.
Many urologists said they received less than five hours of instruction on the treatment of gay and bisexual patients. Gay patients said their sexual satisfaction was not taken into account when they were treated for cancer.
He said it was important to collect data on how treatment affects sexual function for gay and bisexual men. If you don't have the tools to measure aspects of sexual function that are specific to gay and bisexual men, you lose an opportunity to track their progress.
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Youngrae Kim for The New York Times was with Mr. Curtin.
Many of the men Dr. Amarasekera sees at the program's two clinics are unprepared to face another health crisis. One of them is a 59-year-old lawyer in Chicago who is H.I.V. positive, and who said he was not fully warned about how the removal of his prostrate would affect his body.
The lawyer, who asked not to be quoted by name, said there was a wasting because not all of his family members were aware of his H.I.V. status. There is a reduction of the genitals in the body.
He said that the health care system marginalizes gay men when it comes to sexual health and that the prostate is linked to sexual health in gay men. It is a sexual organ and has been removed.
The lawyer said that a previous urologist told him to go forward and enjoy his life.
The treatment is not meant to be callous, but it is not uncommon, according to Gary Dowsett. Gay men are more aware of the fact that many urologists don't realize that the prostrate is a male "G spot".
The urologists should understand the role of the prostate in sexual pleasure, according to Dr. Dowsett. The focus is usually on continence and erections.
Jane Ussher has been studying the effects of cancer on gay men for 20 years.
Gay patients report more concern about loss of ejaculate than heterosexual men because of partial ED. Sex between men is eroticized in visible ejaculate, which is a sign of good sex.
The information gathered through the program would benefit urology as a whole. Straight men are often distressed by the sexual consequences of treatment and feel that they were not adequately warned.
When you don't ask the right questions or counsel patients about the potential impacts of treatment, they are essentially not allowed to make an informed decision.
If they experience side effects from treatment, this can lead to resentment.
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There is a robotic surgery for the removal of a male reproductive organ. There isn't enough research into how treatments affect Black or gay men.
The program would take off in big cities and then spread, according to Dr. Schaeffer.
He said that he wants Dr. Amarasekera to focus on building the blueprints to have them duplicated across the country.
He wanted to create a space that was free of judgement.
He said that cancer can affect men in ways that are not physical. He said that doctors have to meet their patients where they need to be in the treatment of straight men.
The program is not solely focused on the patients of prostrate cancer. It is expanding to be a place for gay men to seek urologic care.
Tom Samolinski, 63, does not have prostrate cancer, but he sought out the program after suffering for years with urinary problems that had never been fixed. He said that he felt heard on issues that he hadn't been able to articulate.
He said that his whole personhood encompassed his being gay.
McKay's donation helped get the program off the ground. He said that if you always do what you have always done, you will get what you have always got.
He said that this was an opportunity for urologists to communicate, train and educate on how to provide better care tailored to the specific needs of gay and bisexual men.
Dr. Rosser agreed. He said that the gay community doesn't talk about cancer.
To talk to gay men about the effects of treatment is something that needs specialists. It is important for gay patients to come out to their specialist. Your future sex life depends on it.
Gene Otto co-hosted a support group for gay and bisexual men with cancer in Palm Springs, Calif., and he sees a need for it as well. He said that one gay patient in his group was given literature about women with cancer.
Mr. Otto said that they were dealing with heterosexual men and their wives more than homosexual men.
The lawyer said his experience with the program goes a long way to address the distrust gay men have towards medical institutions.
He is still with the man he began dating before he was diagnosed, and they are planning a wedding. He said that sex is still a great pleasure.
That is what Dr. Amarasekera wants for his patients.
He said that many men with cancer focus on the warmth in their relationships rather than the heat. It is important to pay attention to the warmth. The heat is not over. We can get you back.
