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09-05-2023 | Prostate cancer | News

Prostate cancer in transgender women ‘not so rare’

Author: Shreeya Nanda


medwireNews: A chart review of the Veterans Affairs (VA) health system indicates that there are around 14 cases of prostate cancer per year among transgender women.

The researchers drew on the VA records dating between January 2000 and November 2022 to identify 449 individuals with prostate cancer and transgender identity codes.

Of these, 155 (35%) were confirmed transgender women, which gave an estimated annual incidence of approximately 14 cases.

The patients were aged a median of 61 years at diagnosis, had a median prostate-specific antigen (PSA) level of 6.8 ng/mL, and the majority were White (88%) and had never used estrogen as feminization therapy (75%). Among former and current estrogen users, the median duration of use was 32 months.

Just under half of the prostate cancer cases were biopsy grade 1 (43%) and clinical stage T1 (45%), and all cases were screen detected.

“This case series demonstrated that prostate cancer occurs in transgender women and is not as rare as published case reports might suggest,” write Farnoosh Nik-Ahd (University of California, San Francisco, USA) and co-investigators in a research letter to JAMA.

“However, rates were lower than expected based on prior prostate cancer incidence estimates in cisgender male veterans.”

Using data from 2005 to 2019, the authors estimated the age-weighted mean number of cases among cisgender individuals at 331 per 100,000 in 2011 (the median year of transgender identity entry in the VA).

“Given estimates of 10 000 transgender women in the VA, 33 cases per year would be expected. Instead, only about 14 per year were observed,” they note.

Nik-Ahd and colleagues continue: “Lower rates may stem from less PSA screening owing to barriers including lack of prostate cancer risk awareness or stigma, the suppressive effects of estrogen on prostate cancer development, or prostate cancers being missed in transgender women because of misinterpretation of ‘normal’ PSA levels among those receiving gender-affirming hormone therapies.”

And they conclude: “Future work is needed to optimize prostate cancer detection strategies in transgender women.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2023 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA 2023; doi:10.1001/jama.2023.6028