PROSTATE cancer may be more common among transgender women than previous case reports suggest. Further analysis showed that transgender women who take oestrogen may also experience delayed prostate cancer diagnosis. Farnoosh Nik-Ahd, University of California, San Francisco, USA commented that transgender people remain incredibly marginalised and much remains to be learned about their health outcomes, adding that “one important area of research is how to best perform screening of birth organs, such as the prostate.” The research team therefore focused on prostate cancer in transgender women as previous research is limited to 10 case reports.
Data was pooled from the Veterans Affairs Health System, including all adults with an International Classification of Diseases (ICD) code for prostate cancer and at least one code for transgender identity between January 2000–November 2022. Data related to gender-affirming hormone therapy used, prostate-specific antigen (PSA), bilateral orchiectomy, disease stage, grade group, and PSA density were collected for each participant.
The included population was 499 patients (median age at diagnosis: 61 years; 88% white; median PSA: 6.8 ng/mL), of whom 155 patients were confirmed transgender women with prostate cancer. Participants formed three test groups based on their oestrogen therapy use: never used (n=116), formerly used but stopped prior to prostate cancer diagnosis (n=17), and actively used at diagnosis (n=22). Analysis showed biopsy Grade Group 1 or 2 disease in 71% of participants with no previous oestrogen use, 56% with former oestrogen use, and 53% with oestrogen at diagnosis. Biopsy Grade Group 4 or 5 was seen in 23% of patients with no previous oestrogen, 25% of former oestrogen users, and 35% reporting active oestrogen use at diagnosis. Finally, PSA density was 0.21 ng/mL/g, 0.26 ng/mL/g, and 0.31 ng/mL/g, respectively for the three test groups.
Nik-Ahd summarised that researchers are only beginning to understand prostate cancer in this population. However, they stressed that “transgender women should still be considered for prostate cancer screening, and PSA values should be interpreted with caution for those on gender-affirming hormones.” They hope to see “prostate cancer screening guidelines that are inclusive of transgender women,” in the near future.