SAN FRANCISCO — Transgender women still face a major risk from prostate cancer, a new report warns. In the largest study of its kind, researchers in California estimate that the risk of developing the disease leads to about 14 cases for every 10,000 people. The study explains that gender-affirming surgery does not remove prostates from transgender women. With the disparities and discrimination in transgender care, study authors say there is not much research about their risk of prostate cancer after completing the procedure.
“What we know about prostate cancer to date is almost exclusively based on cisgender men,” says lead study author Farnoosh Nik-Ahd, MD, a urology resident at the University of California-San Francisco. “This is an important first step in reshaping how clinicians think about prostate cancer in transgender women.”
The study took 22 years of data from the Veterans Affairs Health System and found 155 confirmed transgender women with prostate cancer. The average age of diagnosis was 61, with 88 percent being White patients. According to the study authors, there are possible racial disparities as only eight percent of those affected were Black. Among Black cisgender men, the risk of prostate cancer is much higher.
The team organized the information based on whether patients used estrogen. Of the 155 prostate cancer patients, 116 never used estrogen, 17 used estrogen but stopped after getting their cancer diagnosis, and 22 were still using estrogen. In all, the risk adds up to approximately 14 prostate cancer cases for every 10,000 transgender women.
While it may not seem like a lot at first glance, the authors note that estrogen may have affected people’s cancer risk. Using estrogen could have helped with delaying diagnoses. Additionally, there could have been other reasons for lower prostate cancer rates, such as having fewer PSA screenings, misinterpretation of PSA levels for people undergoing gender-affirming therapies, stigma, a lack of awareness about prostate cancer risk, and estrogen’s effects.
“We still have a lot of work to do to determine optimal prostate cancer screening for transgender women on estrogen and related treatments,” adds Matthew R. Cooperberg, MD, MPH, a medical researcher in UCSF’s Department of Urology in a media release. “This study should be a reminder to clinicians and patients alike that, regardless of gender, people with prostates are at risk for prostate cancer.”
The study is published in the Journal of the American Medical Association.