Restore: Improving Sexual Outcomes of Gay and Bisexual Prostate Cancer Survivors

翻译后摘要：本申请，在回应PA-15-261，“研究导致干预措施，以改善健康 性和性别少数群体的差异”，在三个领域推动了研究。前列腺癌（PCa） 同性恋、双性恋和其他男男性行为者（GBM）中第二常见的癌症， 记录的差异，但它是严重不足的研究。因为同性恋不同于阴道性交， 生理学上;来自614项研究的结果集中在异性恋男性可能不会推广到GBM， PCa。目前还没有专门针对PCa GBM幸存者的康复研究，因此临床医生没有 相关研究，以告知他们的GBM患者的最佳实践。第二，大多数PCa研究都测试了一种或 康复部分。我们将进行第一项临床实践状态的治疗研究 对GBM的生活质量进行综合康复计划，包括泌尿和性功能 和麻烦的措施。第三，几乎所有的PCa研究都集中在最近接受PCa治疗的男性身上。我们将 采用分层设计，研究最近接受治疗的GBM（过去2年）和治疗后的GBM（2年以上）。 这项研究建立在我们在Restore中的发现基础上，R21是第二项对GBM伴PCa的研究， 由NCI资助，第一个出版。我们进行了N=41次深入的定性访谈， 良好的饱和度，以及迄今为止最大的GBM与PCa的定量研究（N=193），首先需要 用PCa评估GBM，以及对GBM的同性伴侣和护理者的首次研究。参与者 形容根治性乳房切除术让他们“蒙羞”、“致残”、“不如其他男同性恋”， “严重抑郁”大多数（88%）报告持续的性挑战导致生活质量下降， 心理健康状况较差，身份认同面临挑战，初级关系恶化。8人中只有3人（38%） 作为治疗的一部分，讨论了大多数GBM通常经历的结果。没有证据 任何专业康复标准;事实上，大多数GBM只是治疗自己。 这项研究的长期目标是改善PCa GBM幸存者的健康状况，并提供一个 康复的证据基础。在目标I中，我们将开发一个针对GBM的在线康复计划， 解决了PCa治疗的性和泌尿影响。在目标二中，我们将进行比较 招募研究，以确定招募450名患有PCa的GBM的最佳方法。在目标III中，我们将评估 量身定制的性功能和泌尿功能康复计划。我们将进行一项为期24个月的随机 结构化康复与常规护理的对照试验。本RCT将确定结构化 康复计划可以有效地解决PCa引起的主要性和泌尿问题 治疗作为第一个治疗研究，重点是GBM与PCa（以及口交和肛交），它解决了 长期存在的健康差距。该研究具有很大的潜力，可以改变PCa对GBM的康复， 为临床医生提供关键的证据基础，并为所有PCa幸存者提供康复结果。

Abstract: This application, in response to PA-15-261, “Research leading to interventions to ameliorate health disparities of sexual and gender minorities”, advances research in three areas. First, prostate cancer (PCa) is the second most common cancer among gay, bisexual, and other men who have sex with men (GBM), with documented disparities, yet it is severely under-researched. Because gay sex differs from vaginal sex, physiologically; the results from 614 studies focused on heterosexual men likely do not generalize to GBM with PCa. There have been no rehabilitation studies specific to GBM survivors of PCa, so clinicians have no relevant studies to inform best practice with their GBM patients. Second, most PCa studies have tested one or rehabilitation components. We will conduct the first treatment study of a state of clinical practice comprehensive rehabilitation program on GBM's quality of life, including on both urinary and sexual function and bother measures. Third, almost all PCa studies have focused on men recently treated for PCa. We will study both GBM recently treated (last 2 years) and GBM post-treatment (2+ years), using a stratified design. This study builds on our findings in Restore, an R21 which was only the second study of GBM with PCa to be funded by NCI, and the first to reach publication. We conducted N=41 in-depth qualitative interviews with good saturation, and the largest quantitative study of GBM with PCa to date (N=193), the first needs assessment of GBM with PCa, and the first study of same sex partners and care-givers of GBM. Participants described radical prostatectomy as leaving them “humiliated,” “maimed”, “less than other gay men,” and “severely depressed.” Most (88%) reported ongoing sexual challenges contributing to decreased quality of life, poorer mental health, identity challenges and deteriorated primary relationships. Only three of the eight (38%) outcomes commonly experienced by most GBM were discussed as part of treatment. There was no evidence of any standard of professional rehabilitation; indeed, most GBM just treated themselves. The long-term objective of this research is to improve the health of GBM survivors of PCa and to provide an evidence base for rehabilitation. In Aim I, we will develop an online rehabilitation program tailored for GBM that addresses both the sexual and urinary effects of PCa treatment. In Aim II, we will conduct a comparative recruitment study to identify best methods to recruit 450 GBM with PCa. In Aim III, we will evaluate the effects of the tailored rehabilitation program on sexual and urinary outcomes. We will conduct a 24 month, randomized controlled trial of structured rehabilitation versus routine care. This RCT will identify whether a structured rehabilitation program is effective in addressing the major sexual and urinary problems caused by PCa treatment. As the first treatment study to focus on GBM with PCa (and also on oral and anal sex), it addresses a long-standing health disparity. The study has high potential to transform rehabilitation for GBM with PCa, provide a critical evidence base for clinicians, and inform rehabilitation outcomes for all PCa survivors.