Study assesses prostate cancer prevalence among transgender women

Findings from a recent Cedars-Sinai Cancer Center study suggest that prostate cancer among transgender women may be more prevalent than previously believed, but lower compared with cisgender men.^1,2

Those who were on estrogen at the time of diagnosis were found to have the most aggressive disease.

The results were simultaneously presented during the 2023 American Urological Association Annual Meeting in Chicago, Illinois and published in JAMA.

“The entire medical literature on prostate cancer in transgender women, prior to this study, consisted of 10 case reports, leading some to believe it was rare. But this paper shows it isn’t as rare as those case reports suggest. Transgender women, no matter what gender-affirming surgeries they may or may not have had, have prostates and are at risk of prostate cancer,” said senior author Stephen J. Freedland, MD, in a news release on the findings.² Freedland is the Warschaw Robertson Law Families Chair in prostate cancer and an associate director for training and education at Cedars-Sinai in Los Angeles, California.

The study retrospectively analyzed data on prostate cancer patients in the Department of Veteran Affairs between 2000 and 2022. From this, 155 transgender women were identified, leading to an estimate of about 14 cases per year.

Among those patients, 116 never used estrogen, 17 formerly used estrogen, and 22 were actively using estrogen at the time of diagnosis. Those who were on estrogen at the time of diagnosis were found to have the most aggressive disease, with 35% of active users presenting with grade group 4 or 5 disease, compared with 23% who never used estrogen and 25% of former users. Transgender women also presented with a higher stage of prostate cancer in comparison with cisgender men, with only 16% of cisgender men having grade group 4 or 5 disease.

This difference could be, in part, due to insufficient data on proper screening measures among this patient population, Freedland explained.

“In cisgender men, we have traditionally considered PSA [prostate-specific antigen] levels below 4 to be safe, but for patients on gender-affirming hormone therapy, PSA levels decrease dramatically and can even go down to 0. We don’t yet have data to determine where the cutoff value for PSA should be in transgender women, but we suspect that some of these cancers are currently being missed because the cutoff value being used is too high,” said Freedland in the news release.

Further data showed that among all patients, only 8% of transgender women identified in the study where Black, compared with 29% among cisgender male veterans.

Freedland concluded, “We hope this report is eye-opening to people for whom this disease wasn’t even on the radar. The most important thing for transgender women and their health care providers to remember is that prostate cancer screening shouldn’t be neglected.”

References

1. Nik-Ahd F, Hoedt AD, Butler C, et al. Prostate cancer in transgender women in the Veterans Affairs Health System, 2000-2022. JAMA Network. [published online ahead of print April 29, 2023.] Accessed May 3, 2023. doi: 10.1001/jama.2023.6028.

2. Research: Prostate cancer studies explore new treatment, health disparities. News release. Cedars-Sinai. April 29, 2023. Accessed May 3, 2023. https://www.newswise.com/articles/research-prostate-cancer-studies-explore-new-treatment-health-disparities?sc=sphr&xy=10016681