Transgender Women May Be Underdiagnosed With Prostate Cancer

WEDNESDAY, May 3, 2023 (HealthDay News) -- Prostate cancer is not that rare among transgender women, according to a research letter published online April 29 in the Journal of the American Medical Association.

Farnoosh Nik-Ahd, M.D., from the University of California in San Francisco, and colleagues characterized prostate cancer in transgender women. The analysis included 449 patients with prostate cancer and transgender identity codes identified from electronic medical records within the Veterans Affairs health system (2000 to 2022).

The researchers found that 155 patients (35 percent; an estimated 14 cases per year) were confirmed transgender women with prostate cancer: 116 never used estrogen, 17 formerly used estrogen, and 22 actively used estrogen at diagnosis. Screening detected all prostate cancer diagnoses at a median age of 61 years (88 percent White) and a median prostate-specific antigen level of 6.8 ng/mL. Among confirmed transgender women with prostate cancer, the median duration of estrogen use was 32 months for former and active estrogen users. Nearly half (50 of 115) were biopsy grade group 1 and clinical stage T1 (49 of 108). Nearly all (152 of 155) had not undergone bilateral orchiectomy. Among patients with no prior estrogen use, biopsy grade group 1 or 2 was found in 58 of 82 patients versus nine of 16 with former estrogen use and nine of 17 with estrogen use at diagnosis. Biopsy grade group 4 or 5 was seen in 19 of 82 patients who never used estrogen, four of 16 former users, and six of 17 active users.

"This case series demonstrated that prostate cancer occurs in transgender women and is not as rare as published case reports might suggest," the authors write. "However, rates were lower than expected based on prior prostate cancer incidence estimates in cisgender male veterans."

One author disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text