Prostate Cancer in Transgender Women in the Veterans Affairs Health System, 2000-2022

Nik‐Ahd, Farnoosh; Hoedt, Amanda M. De; Butler, Christi; Anger, Jennifer T.; Carroll, Peter R.; Cooperberg, Matthew R.; Freedland, Stephen J.

doi:10.1001/jama.2023.6028

Cited by 15 publications

(14 citation statements)

References 7 publications

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“…While the incidence of prostate cancer among transgender women is largely unknown, recent data demonstrate that the incidence of and mortality due to prostate cancer in transgender women are significant. A recent case series demonstrated a prostate cancer incidence of 14 cases per 10 000 transgender women, which is higher than in previously published data, and reported a higher incidence of aggressive disease among transgender women receiving hormone therapy due to possible diagnostic delay from the misinterpretation of PSA values in the setting of suppressive effects of estrogen. Despite the measurable risk of prostate cancer in transgender women, there are few studies on PSA screening in transgender women.…”

Section: Discussionmentioning

confidence: 63%

“…Specifically, transgender women had lower annual income, higher unemployment rates, lower educational attainment, and higher health care cost barriers compared with cisgender men, trends that are well-described in the literature . Given the profound effect of these factors on comorbid conditions and health care access, we matched cisgender men and transgender women by these sociodemographic factors to minimize confounding the effects of clinician-specific interactions . It is well established that a significant barrier in transgender health care is lack of clinician competency, as most clinicians have little to no formal training in transgender care .…”

Section: Discussionmentioning

confidence: 99%

“… 16 , 17 , 18 , 19 Given the profound effect of these factors on comorbid conditions and health care access, we matched cisgender men and transgender women by these sociodemographic factors to minimize confounding the effects of clinician-specific interactions. 12 , 20 It is well established that a significant barrier in transgender health care is lack of clinician competency, as most clinicians have little to no formal training in transgender care. 13 , 15 Transgender patients have reported significant difficulty in finding knowledgeable clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Recent screening rates based on patient demographic characteristics were calculated and compared using analysis of variance tests. As recent data report potential associations among Black race, transgender female identity, and prostate cancer diagnoses, we tested the interaction between Black race and transgender women using a likelihood ratio test . As a sensitivity analysis, we also repeated key analyses using the unweighted survey data.…”

Section: Methodsmentioning

confidence: 99%

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Prostate Cancer Screening Uptake in Transgender Women

Kalavacherla,

Riviere,

Kalavacherla

et al. 2024

JAMA Netw Open

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ImportanceThere is no consensus in prostate-specific antigen (PSA) screening guidelines regarding transgender women despite their known prostate cancer risk.ObjectiveTo identify factors associated with recent (within the last 2 years) PSA screening in transgender women compared with cisgender men.Design, Setting, and ParticipantsThis case-control study used data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys to characterize rates of PSA screening for prostate cancer within the past 2 years and multivariable logistic regressions to characterize factors associated with recent screening among transgender women. The BRFSS program of the Centers for Disease Control and Prevention annually surveys over 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. Respondents to the BRFSS who were cisgender men or transgender women 40 years or older and who had complete PSA testing responses and no prostate cancer history were included; 313 transgender women and 138 937 cisgender men met inclusion criteria. Matching was performed by age, race and ethnicity, educational level, employment, annual income, survey year, and cost barriers to care. Data were collected on November 2, 2022, and analyzed from November 2, 2022, to December 3, 2023.Main Outcomes and MeasuresRates of and factors associated with recent PSA screening in transgender women.ResultsAmong the 1275 participants included in the matched cohort (255 transgender women and 1020 cisgender men; 570 [44.7%] aged 55-69 years), recent PSA screening rates among transgender women and cisgender men aged 55 to 69 were 22.2% (n = 26) and 36.3% (n = 165), respectively; among those 70 years and older, these rates were 41.8% (n = 26) and 40.2% (n = 98), respectively. In the matched cohort, transgender women had lower univariable odds of recent screening than cisgender men (odds ratio [OR], 0.65 [95% CI, 0.46-0.92]; P = .02). In a hierarchical regression analysis adding time since the last primary care visit, effect size and significance were unchanged (OR, 0.61 [95% CI, 0.42-0.87]; P = .007). After adding whether a clinician recommended a PSA test, there was no statistically significant difference in odds of screening between transgender women and cisgender men (OR, 0.83 [95% CI, 0.45-1.27]; P = .21). The results were further attenuated when clinician-led discussions of PSA screening advantages and disadvantages were added (OR, 0.87 [95% CI, 0.47-1.31]; P = .32). In a multivariable logistic regression among transgender women, having a recommendation for PSA testing was the factor with the strongest association with recent screening (OR, 12.40 [95% CI, 4.47-37.80]; P &lt; .001).Conclusions and RelevanceIn this case-control study of one of the largest cohorts of transgender women studied regarding PSA screening, the findings suggest that access to care or sociodemographic factors were not principal drivers of the screening differences between transgender women and cisgender men; rather, these data underscore the clinician’s role in influencing PSA screening among transgender women.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Prostate Cancer Screening Uptake in Transgender Women

Kalavacherla,

Riviere,

Kalavacherla

et al. 2024

JAMA Netw Open

Self Cite

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show abstract

“…Estimates for some countries are as high as 1.2% ( 23 ). As society at large begins to better recognize and understand the social and psychological issues surrounding transgender patients, more transgender individuals will feel comfortable in seeking urologic care, so urologists need to be better educated about social, behavioral, physiological, and anatomical issues that face transgender patients ( 24 ).…”

mentioning

confidence: 99%