The state of PSA counseling in male‐to‐female transgender patients in the U.S.

Abstract

Background Morbidity and mortality from prostate cancer (PCa) are known to vary heavily based on socioeconomic and demographic risk factors. We sought to describe prescreening PSA (prostate‐specific antigen) counseling (PPC) rates amongst male‐to‐female transgender (MtF‐TG) patients and non‐TG patients using the behavioral risk factor surveillance system (BRFSS). Methods We used the survey data from 2014, 2016, and 2018 BRFSS and included respondents aged 40–79 years who completed the “PCa screening” and “sexual orientation and gender identity” modules. We analyzed differences in age, education level, income level, marital status, and race/ethnicity using Pearson's χ2 tests. The association of PPC with MtF‐TG status and other patient characteristics was evaluated using multivariate logistic regression. Results A total of 175,383 respondents were included, of which 0.3% identified as MtF‐TG. Overall, 62.4% of respondents reported undergoing PPC. On univariate analysis, PPC rates were lower among MtF‐TG respondents when compared to the non‐TG group (58.3% vs. 62.4%, p = 0.03). MtF‐TG respondents were also more likely to report lower education level (p < 0.01), lower‐income level (p < 0.01), and were less likely to be white (p < 0.01) than non‐TG respondents. However, multivariate analysis adjusting for these respondent features demonstrated an association between higher income and higher education levels with increased odds of PPC, but no association was demonstrated between MtF‐TG status and PPC rates. PPC rates for the MtF‐TG and non‐TG populations did not change significantly over time. Conclusions Although PPC was less frequently reported among MtF‐TG respondents than in the non‐TG group on univariate analysis, this association was not demonstrated when controlling for confounders, including education and income levels. Instead, on multivariate analysis, low education and income levels were more predictive of PPC rates. Further research is needed to ensure equivalent access to prescreening counseling for patients across the socioeconomic and gender identity spectrum.

Prostate Cancer in Sexual Minorities: Epidemiology, Screening and Diagnosis, Treatment, and Quality of Life

“…Transgender participants in Ma et al's study were less likely to have PSA screening [35]. This is supported by findings from two additional studies that indicated that transgender women were less likely than cis-gendered men to ever have a risks versus benefits discussion about PSA screening with healthcare providers [38,39]. It is plausible that transgender women may find it challenging to disclose their personal sexual identity history to primary care physicians, leading to the possibility of not being offered the opportunity to talk about PSA screening when it is appropriate [5].…”

Prostate Cancer Screening Uptake in Transgender Women

“…Our analysis highlights baseline intersectional obstacles that heighten the disconnection between health care and transgender individuals . 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 .…”

“…15 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. 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.…”

“…These data are consistent with literature that establishes educational attainment as a factor that positively influences PSA screening use within the general population. 20 , 23 In fact, a recent study 19 showing lower prescreening PSA counseling rates for transgender women compared with cisgender men reported that this association was not maintained when controlling for educational level. Specific to transgender women, a Thai questionnaire study 3 demonstrated that increased prostate cancer awareness among transgender women was associated with higher educational levels, knowledge that they retained their prostate after gender-affirming surgery, and education by the gender-affirming surgeon regarding the possibility of prostate cancer.…”