Prostate cancer in transgender women: what does a urologist need to know?

Abstract

ObjectiveTo review of the existing literature, current guidelines and standard of practice related to prostate cancer in transgender women, as the transgender population share many of the same healthcare needs as their cisgender counterparts, but may have additional specialist needs. Materials and methodsWe performed a non-systematic review of the literature, current guidelines and standard of practice related to prostate cancer in transgender women. ResultsOur search revealed 10 case reports of prostate cancer in transgender women, four specialist opinion papers, six cohort studies, and four systematic reviews. The information in these publications were assimilated to produce a review of prostate cancer in transgender women. ConclusionThe risk of prostate cancer in transgender women who are not on gender-affirming hormone therapy (GAHT) or who have not had gender-affirming surgery (GAS) and gender non-conforming individuals (who may never commence GAHT or have GAS) is the same as that in the cis male population. In these patients, healthcare professionals need to be able to discuss screening, diagnostic and treatment options considering future wishes for gender-affirming treatment. Prostate cancer incidence in transgender women on GAHT or following GAS is lower than age-matched cis-male counterparts, but diagnosis and treatment is more nuanced. The present review discusses the existing literature about development and incidence of prostate cancer in this population, and makes recommendations about screening, the usefulness of diagnostic tools e.g. prostate-specific antigen and magnetic resonance imaging, and considerations when formulating treatment. Potential directions for future research are discussed, which will hopefully lead to development of robust evidence-based guidelines for the diagnosis and management of prostate cancer in transgender women.

Prostate cancer awareness among transgender women after gender‐affirming surgery

“…This statistics belongs not only to cis‐men but also to TGW (who are assigned male at birth, except in countries with legally‐accepted gender change where TGW are counted as female in the databases). The pathogenesis of PC in TGW remains unclear, and practice guidelines for transgender patient care are low or nonexistent universally 1 …”

“…The predictor variables postulated to relate with PCA based on a literature review, 1,7 that is demographic, clinical, operative, or postoperative variables. The demographic variables were sexual orientation (homosexual [TGW are a biological male at birth] vs. bisexual), age (adjusted according to the median: 18–26 vs. ≥26 years), educational level (bachelor or higher vs. other), career (in service sectors [e.g., restaurants, spas] vs. in office sectors [e.g., manager]), and monthly net income (<40,000 Thai Baht [TB, or ca.…”

“…Because of the rarity (estimated by published data), diagnosis and management of prostate cancer (PC) in transgender women (TGW) remain ill‐defined, 1–4 probably because of societal, legal, and medical discrimination and stigmatization 4–6 . Apart from health care as for cis‐persons, TGW requires special care including and/or related to gender‐affirming hormone therapy (GAHT) and gender‐affirming surgery (GAS).…”

“…Apart from health care as for cis‐persons, TGW requires special care including and/or related to gender‐affirming hormone therapy (GAHT) and gender‐affirming surgery (GAS). Marginalized groups such as Black, Asian, and minority ethnics in western countries, amidst LGBTQ + (lesbian, gay, bisexual, transgender, queer [or sometimes questioning], and others), have to endure “minority stress” (chronically high levels of stress due to social prejudice, discrimination, violence, and isolation), for example, social bullying, and denied access to health care 1,7,8 …”

“…Radical prostatectomy in individuals with neovagina may lead to recto‐vaginal or urethro‐vesico‐neovaginal fistulae, and sphincter damage resulting in urinary incontinence. Radiotherapy can cause urethral and neovaginal stenosis and increases the risks of urinary retention, dyspareunia, neovaginal cancer, or postradiation sarcoma 1,2,9–11 . Prostate cancer awareness (PCA) and prevention among TGW after GAS are therefore important.…”