“If I Can't Live as a Man, I'd Rather Not Live at All”: Older Prostate Cancer Patients Discuss Doctors' Attitudes Toward Their Sexuality

Prostate cancer is the most common cancer among men in the Western world and frequently requires treatment with androgen deprivation therapy (ADT), which carries significant side effects, including loss of sexual function. This study explores how older men with prostate cancer perceive physician communication about the sexual and emotional impact of ADT, and whether they feel their values, masculinity, and quality-of-life concerns are considered in treatment decisions. This qualitative study employed an interpretative phenomenological approach based on in-depth interviews with 25 men aged 60-80 undergoing or having completed ADT. Participants interviewed about their experiences with cancer treatment, physician communication, and their perceptions of how sexuality and masculinity were addressed. Interviews were transcribed and thematically analyzed. Two central themes emerged: (i) physicians often minimized or overlooked the significance of sexual function and masculinity in older men, reflecting ageist and paternalistic assumptions; and (ii) information about ADT and its effects was frequently presented in generic or emotionally detached ways, with limited sensitivity to individual preferences or emotional readiness. While most patients received some information about side effects, many described the communication as dismissive or lacking in nuance. Several reported feeling excluded from shared decision-making. Older men undergoing ADT often feel that their sexuality and masculinity are undervalued in clinical care. Physician communication may reflect ageist assumptions and insufficient engagement with patient preferences. These findings underscore the need for more patient-centered, culturally competent, and age-sensitive approaches in prostate cancer care, particularly around sensitive issues such as sexual function.