Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges

Deebel, Nicholas A.; Morin, Jacqueline; Autorino, Riccardo; Vince, Randy; Grob, B. Mayer; Hampton, Lance J.

doi:10.1016/j.urology.2017.08.032

Cited by 71 publications

(40 citation statements)

References 25 publications

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“…This complements our observation that trans women with prostate cancer had a median age of 47 years at start of hormone treatment. Trans women in previously reported cases of prostate cancer also started hormone treatment at an older age ( 27 ). Possibly androgen deprivation slowed further progression of these carcinogenic foci for many years.…”

Section: Discussionmentioning

confidence: 99%

Prostate Cancer Incidence under Androgen Deprivation: Nationwide Cohort Study in Trans Women Receiving Hormone Treatment

Nie

Blok

Sluis

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Trans women (male sex assigned at birth, female gender identity) mostly use anti-androgens combined with estrogens and can subsequently undergo vaginoplasty including orchiectomy. Because the prostate remains in situ after this procedure, trans women are still at risk for prostate cancer. Objective The incidence of prostate cancer in trans women using hormone treatment. Design In this nationwide retrospective cohort study, data of participants were linked to the Dutch national pathology database (PALGA) and to Statistics Netherlands, to obtain data on prostate cancer diagnosis and mortality.  Setting Gender identity clinic. Participants Trans women who visited our clinic between 1972 and 2016 and received hormone treatment were included. Main Outcome Measures Standardized incidence ratios (SIRs) were calculated using the number of observed prostate cancer cases in our cohort and the number of expected cases based on age-specific incidence numbers from the Netherlands Comprehensive Cancer Organization. Results The study population consisted of 2,281 trans women with a median follow-up time of 14 years (interquartile range 7-24), and a total follow-up time of 37,117 years. Six prostate cancer cases were identified after median 17 years of hormone treatment. This resulted in a lower prostate cancer risk in trans women compared to Dutch reference males (SIR 0.20, 95CI 0.08 to 0.42). Conclusions Trans women receiving androgen deprivation therapy and estrogens have a substantially lower risk for prostate cancer compared to the general male population. Our results support the hypothesis that androgen deprivation has a preventive effect on the initiation and development of prostate cancer.

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Section: Discussionmentioning

confidence: 99%

Prostate Cancer Incidence under Androgen Deprivation: Nationwide Cohort Study in Trans Women Receiving Hormone Treatment

Nie

Blok

Sluis

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…As prostatic cancer has been traditionally been thought to be androgen dependent, one would expected that these individuals may be protected from developing prostatic cancer. [ 46 ] However, rare cases of prostate cancer have been reported in transgender females. [ 46 ] It is possible that these cancers existed before the start of hormone manipulation or factors other than androgen (but including estrogen) could drive the development of prostate cancer.…”

Section: Ethodsmentioning

confidence: 99%

“…[ 46 ] However, rare cases of prostate cancer have been reported in transgender females. [ 46 ] It is possible that these cancers existed before the start of hormone manipulation or factors other than androgen (but including estrogen) could drive the development of prostate cancer. An increased estrogen to dihydrotestosterone ratio has been shown to have the highest effect on stromal cell growth.…”

Section: Ethodsmentioning

confidence: 99%

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IDEA group consensus statement on medical management of adult gender incongruent individuals seeking gender reaffirmation as female

Majumder

Chatterjee

Maji

et al. 2020

Indian J Endocr Metab

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Cross sex hormone therapy (CSHT) is a strongly desired medical intervention for gender incongruent individuals. The goal is to change secondary sex characteristics to facilitate gender presentation that is consistent with the desired sex. When appropriately prescribed CSHT can greatly improve mental health and quality of life for gender incongruent individuals. Appropriate care for gender incongruent individuals in India is almost absent due to lack of country specific guideline and lack of training amongst the medical professionals. This document is intended to assist endocrinologists and physicians whose adult gender incongruent client is seeking gender reaffirmation as female (transfeminine). These individuals require a safe and effective CSHT regimen that will suppress endogenous male hormone secretion and maintain physiologic levels of female sex hormone. In this document, we offer suggestions based on an in-depth review of Guidelines of Endocrine Society, The World Professional Association for Transgender Health guidelines, the Sappho Good Practice Guide of India and collegial meetings with expert Indian clinicians working in this field. Clinicians represented in our expert panel are not gender specialists by training but have developed expertise due to the volume of gender incongruent individuals they manage. This consensus statement on medical management provides protocols for the prescribing clinician relating to diagnosis, baseline evaluation and counselling, prescription planning for feminizing hormone therapy and anti-androgen therapy, targets for monitoring hormone therapy, choice of therapy, clinical and biochemical monitoring, recommending sex reaffirmation surgery and peri-operative hormone therapy. The recommendations made in this document should not be perceived as a rigid set of guidelines and the treating clinicians are encouraged to modify our suggested protocols to address emerging issues.

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“…We did not exclude articles based on date of publication. However, we excluded articles about transgender and intersex persons with prostates, as their experiences navigating the healthcare system are distinct with specific barriers to care and effects of transitional hormones on the prostate that warrant an independent comprehensive review (Deebel et al, 2017).…”

Section: Eligibility Criteriamentioning

confidence: 99%

Sexual minority men and the experience of undergoing treatment for prostate cancer: An integrative review

2019

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Introduction Gay, bisexual and queer (GBQ) men with prostate cancer have unique experiences of the prostate cancer journey. The current integrative review aimed to synthesise existing scientific literature for the purpose of identifying GBQ men's psychosocial experience of undergoing treatment for prostate cancer. Methods We utilised the Whittemore and Knafl (Journal of Advanced Nursing, 52, 546–553) integrative review methodology and the Garrard (Health sciences literature review made easy. Jones & Bartlett Publishers) matrix method. Results After a systematic search, 18 quantitative and non‐empirical studies were included for thematic analysis. Three themes emerged: (a) Prostate cancer, and its treatment affect sexual wellbeing, including negatively affecting their relationships and sense of self. (b) Health care is heteronormative, exemplified by clinicians dismissing GBQ men's concerns, leading GBQ men to fare worse on psychosocial outcomes, including treatment satisfaction, in comparison with heterosexual counterparts. (c) Prostate cancer affects social support. GBQ men rely on an expansive support network, but often isolate themselves during prostate cancer treatment as to not be burden others. Conclusion Psychosocial supportive care needs to address GBQ men's sexual, emotional and social needs. Future psycho‐oncologic trials are needed, especially on GBQ‐specific peer‐support interventions.

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Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges

Cited by 71 publications

References 25 publications

Prostate Cancer Incidence under Androgen Deprivation: Nationwide Cohort Study in Trans Women Receiving Hormone Treatment

Prostate Cancer Incidence under Androgen Deprivation: Nationwide Cohort Study in Trans Women Receiving Hormone Treatment

IDEA group consensus statement on medical management of adult gender incongruent individuals seeking gender reaffirmation as female

Sexual minority men and the experience of undergoing treatment for prostate cancer: An integrative review

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