Dr Mataroria Lyndon explains PSA testing, family history and the prostate, bowel and anal cancer risks gay men should understand.
I’m 45, and my father was diagnosed with prostate cancer in his 60s. When should I begin screening, and does being gay change anything about how prostate health should be discussed or managed? And as a sexually active gay man, am I any more susceptible to the likes of colon, bowel or any other specific cancers?
Having a father who has had prostate cancer does increase your own risk, so at 45, this is a good time to talk with your GP about prostate cancer testing.
In Aotearoa, it’s recommended that men with a family history of prostate cancer start discussing screening from age 40, rather than waiting until 50. Screening typically involves both a PSA (prostate-specific antigen) blood test and, where appropriate, a digital rectal examination, depending on your symptoms, history and preferences.
Being gay, bisexual or having anal sex is not known to increase your risk of developing prostate cancer. However, it is relevant when preparing for a PSA test. Current guidance recommends avoiding ejaculation, receptive anal sex and heavy exercise for 48 hours beforehand, as these can temporarily raise your PSA level.
Being a sexually active gay man does not, by itself, increase your risk of bowel or colon cancer. The main risk factors include increasing age, family history, smoking, alcohol, excess weight and aspects of diet.
Anal cancer is different from bowel cancer. Gay, bisexual and other men who have sex with men have a higher risk of anal cancer because of greater exposure to certain strains of HPV, with the risk particularly increased in people living with HIV. HPV vaccination can reduce this risk, and condoms can reduce, but not completely prevent, HPV transmission.
At age 45, it is worth asking your GP about vaccination if you have not previously received it; in New Zealand, it is registered through age 45, although it is generally not funded after age 26. Routine anal-cancer screening is not currently available for most asymptomatic people in Aotearoa, but persistent anal symptoms should always be discussed with a clinician.
