Posted: Monday, May 15, 2023
According to a study published as a research letter in JAMA, transgender women remain at risk for prostate cancer, even after gender-affirmation surgery, suggesting this type of genitourinary cancer may not be as rare in this population as case reports have suggested. Further study is needed to improve prostate cancer detection strategies in transgender women, stated Farnoosh Nik-Ahd, MD, of the University of California San Francisco (UCSF), and colleagues.
“What we know about prostate cancer to date is almost exclusively based on cisgender men,” said Dr. Nik-Ahd in a UCSF press release. “This is an important first step in reshaping how clinicians think about prostate cancer in transgender women.”
Of 449 patients with prostate cancer and transgender identity codes within a Veterans Affairs (VA) health system, 155 (35%) were confirmed transgender women with prostate cancer—an estimated 14 cases per year. In this group of transgender women, 116 had never used estrogen, 17 had once used estrogen but stopped before their diagnosis, and 22 were actively on estrogen. Even with small numbers, this study suggests that transgender women taking estrogen may have experienced a delayed diagnosis. A total of 88% of the patients were White, and 8% were Black.
According to the study authors, lower rates of prostate cancer may have been attributable to less prostate-specific antigen (PSA) screening, misinterpretation of PSA levels in patients on gender-affirming hormone therapies, stigma, and lack of awareness of prostate cancer risk and the effects of estrogen. Therefore, regardless of gender, those with prostates are still at risk for prostate cancer, the noted.
“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.
Disclosure: The study authors reported no conflicts of interest.