Unveiling the Prostate Cancer Risk in Transgender Women

Transgender women retain their prostates following gender-affirming surgery, with an estimated 14 cases of prostate cancer per 10,000 individuals.

The study drew on 22 years of data from the Veterans Affairs Health System. Although the sample size was necessarily small, it is still the largest study of its kind.

Prostate Cancer | Cancer of Prostate - Incidence, Prevention, Causes, Symptoms & Treatment
This cancer affects men over the age of 50 years and screening with rectal examination and PSA can help both in early detection and effective treatment

‘First-ever study of its kind sheds light on the risk of prostate cancer in transgender women post-gender-affirming surgery, revealing an estimated 14 cases per 10,000 individuals.’

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It publishes Saturday, April 29, 2023, in the Journal of the American Medical Association (JAMA) and is timed to the annual meeting of the American Urological Association.

"What we know about prostate cancer to date is almost exclusively based on cisgender men,” said the study’s lead author, Farnoosh Nik-Ahd, MD, a urology resident at UCSF. “This is an important first step in reshaping how clinicians think about prostate cancer in transgender women.”

Unraveling the Risks of Prostate Cancer

Transgender people often face discrimination and disparities, and there has been a growing acknowledgment of the complexities involved in their health care.

Prostate Specific Antigen [PSA] & Prostate Cancer Diagnosis
PSA blood test is specific to prostate gland but not necessarily a cancer specific test but is commonly used to diagnose prostate cancer.

The study found 155 confirmed transgender women with prostate cancer and stratified them according to whether they had used estrogen: 116 had never used estrogen, 17 had once used estrogen but stopped before they were diagnosed with prostate cancer, and 22 were actively on estrogen.

The median age of diagnosis was 61 years, and 88 percent of the patients were white. Just 8 percent were Black, suggesting possible disparities affecting this group. Black cisgender men are at heightened risk of being diagnosed with and dying from prostate cancer.

Prostate Cancer Screening
PSA (Prostate Specific Antigen) test and Digital Rectal Examination are two tests that allow detection of prostate cancer at early stages.

The authors found that prostate cancer occurs in transgender women more frequently than published accounts might suggest, with about 14 prostate cancer cases per 10,000 transgender women.

Understanding the Implications of Gender-Affirming Surgery

While the numbers were small, they suggest that transgender women taking estrogen may have had delayed diagnoses.

Biochemical Recurrence of Prostate Cancer
Biochemical recurrence (BCR) of prostate cancer is a condition that occurs in men who have previously been cured of prostate cancer. In BCR, prostate-specific antigen (PSA) is elevated above normal.

The authors also said that lower rates of prostate cancer may have been due to less PSA screening, misinterpretation of PSA levels in patients on gender-affirming hormone therapies, stigma, lack of awareness of prostate cancer risk, and the effects of estrogen.

“We still have a lot of work to do to determine optimal prostate cancer screening for transgender women on estrogen and related treatments,” said co-senior author Matthew R. Cooperberg, MD, MPH, of the UCSF Department of Urology. “This study should be a reminder to clinicians and patients alike that, regardless of gender, people with prostates are at risk for prostate cancer.”

Source-Eurekalert