Researchers have estimated that about 14 of every 10,000 transgender women may be at risk of developing prostate cancer, according to a new study published by Nik-Ahd et al in JAMA.
Background
Transgender women keep their prostates even after gender-affirming surgery, but the extent to which they remain at risk of prostate cancer was previously unclear. Transgender individuals often face discrimination and disparities, and there has been a growing acknowledgement of the complexities involved in their health care.
"What we know about prostate cancer to date is almost exclusively based on cisgender men,” explained lead study author Farnoosh Nik-Ahd, MD, a resident physician in the Department of Urology at the University of California, San Francisco (UCSF) School of Medicine. “This is an important first step in reshaping how clinicians think about prostate cancer in transgender women,” she emphasized.
Study Methods and Results
In the new study, researchers drew on 22 years of data from the Veterans Affairs Health System to identify 155 confirmed transgender women with prostate cancer and stratify them according to whether they had used estrogen: 116 of the patients had never used estrogen, 17 of them had once used estrogen but stopped before they were diagnosed with prostate cancer, and 22 of them were actively on estrogen.
The median age of diagnosis was 61 years, and 88% of the patients identified as White. However, just 8% of them were Black—suggesting possible disparities affecting this group. Black cisgender men have been known to carry a heightened risk of prostate cancer incidence and mortality.
Further, the authors discovered that prostate cancer may occur in transgender women more frequently than published accounts might suggest—with about 14 prostate cancer cases per 10,000 transgender women.
Conclusions
Although the sample size was small, it was one of the largest studies of its kind. The findings suggested that transgender women taking estrogen may have had delayed diagnoses. The researchers also noted that lower rates of prostate cancer may have been the result of several factors—including fewer prostate-specific antigen screenings, misinterpretations of prostate-specific antigen levels in patients on gender-affirming hormone therapies, stigmas, a lack of awareness of prostate cancer risks, and the effects of estrogen.
“We still have a lot of work to do to determine [the] optimal prostate cancer screening for transgender women on estrogen and related treatments,” stressed co–senior study author Matthew R. Cooperberg, MD, MPH, Professor of Urology at the UCSF School of Medicine. “This study should be a reminder to clinicians and patients alike that, regardless of gender, [individuals] with prostates are at risk for prostate cancer,” he concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
