Sexual function outcomes following prostate cancer treatment in sexual and gender minority populations: a mixed-methods systematic review.

Background: The impact of prostate cancer (PCa) treatments on sexual function outcomes remains poorly understood in heterosexual men and even less so in sexual and gender minority (SGM) patients. This review aims to provide a greater understanding of the unique challenges PCa treatment presents to this population. Methods: A systematic review was conducted using PRISMA guidelines (CRD42024609973). A search was conducted across EMBASE, Ovid MEDLINE, Global Health, APA PsycInfo, APA PsycTherapy and AMED. With inclusion criteria of (I) SGM patients, (II) reported sexual function outcomes, and (III) after PCa treatment of either surgery, radiotherapy, hormone therapy, chemotherapy, or focal therapy. Two independent reviewers conducted data extraction using line-by-line coding within NVivo software (15.0.0). A mixed-methods approach was used to combine data. Independent critical appraisal was conducted using Joanna Briggs Institute checklists and the Mixed Methods Appraisal Tool. Results: Of 12,532 titles reviewed, 35 records met the inclusion criteria. Three main themes were found: sexual implications, psychological implications and relational implications. As the data had minimal inclusion of gender minorities the findings are primarily applicable to sexual minority (SM) patients. Compared to heterosexual counterparts, the negative impact of anejaculation, urinary outcomes and climacturia was greater in SM patients. SM patients are more likely to experience a change in 'sex-role', which can be detrimental to their identity and lead to loss of their 'place' in their sexual community. Conclusions: SM patients face unique sexual function outcomes after PCa treatment. Greater awareness and understanding among healthcare professionals will allow them to provide appropriate information on how treatment impacts sexual activities. Increased awareness and education are crucial to improving care and outcomes in this underserved population. Notably, there is a marked lack of data on gender minority patients, this gap in the literature means meaninful conclusions for this group cannot be drawn. This research will guide the development of more inclusive patient-reported outcome measures (PROMs) that capture the full spectrum of sexual outcomes, many of which are currently overlooked. The Sexual Minorities and Prostate Cancer Scale (SMACS) is a promising start to inclusive PROMs.