Prostate-Specific Antigen Screening in Transgender Patients

Farnoosh Nik-Ahd; Andrew Jarjour; Jane Figueiredo; Jennifer T Anger; Maurice Garcia; Peter R Carroll; Matthew R Cooperberg; Adriana C Vidal; Stephen J Freedland

doi:10.1016/j.eururo.2022.09.007

Prostate-Specific Antigen Screening in Transgender Patients

Eur Urol. 2023 Jan;83(1):48-54. doi: 10.1016/j.eururo.2022.09.007. Epub 2022 Nov 4.

Authors

Farnoosh Nik-Ahd¹, Andrew Jarjour², Jane Figueiredo³, Jennifer T Anger⁴, Maurice Garcia⁵, Peter R Carroll⁶, Matthew R Cooperberg⁶, Adriana C Vidal³, Stephen J Freedland⁷

Affiliations

¹ Department of Urology, University of California-San Francisco, San Francisco, CA, USA. Electronic address: farnoosh.nik-ahd@ucsf.edu.
² College of Osteopathic Medicine of the Pacific, Western University, Pomona, CA, USA.
³ Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁴ Department of Urology, University of California-San Diego Health System, La Jolla, CA, USA.
⁵ Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁶ Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
⁷ Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

PMID: 36344317
DOI: 10.1016/j.eururo.2022.09.007

Abstract

Context: Approximately 0.4-1.3% of the worldwide population is transgender. Although the exact prevalence is unknown, there is an increase in open identification as transgender. Among transgender women (TW), the prostate is retained even after gender-affirmation surgery, thus necessitating ongoing screening for prostate cancer (CaP). However, little is known about CaP screening in this population.

Objective: To assess our current understanding of CaP incidence and prostate-specific antigen (PSA) screening in TW.

Evidence acquisition: We performed a nonsystematic narrative review of all PubMed publications through June 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Given the limited primary research on this subject, case reports were also included. Studies were reviewed to understand PSA screening practices and reports of CaP in this population, as applicable.

Evidence synthesis: There is no consensus regarding PSA screening in TW from any of the major societies, and TW are largely absent from guidelines. Case report data suggest that TW with CaP may have more aggressive disease, and these cancers may have been pre-existing prior to present before gender-affirming hormone therapy (GAHT) or be castrate-resistant.

Conclusions: We are in the infancy of our understanding of PSA screening in TW. Important avenues for future research include understanding the risks/benefits of PSA screening in TW, how best to mitigate potential negative psychological effects of PSA screening in TW, establishing baseline PSA values for those on GAHT (and determining what values should be considered "elevated"), establishing when to initiate PSA screening for those on GAHT, and establishing the accuracy of biomarkers for those undergoing GAHT.

Patient summary: We examined patterns of prostate cancer screening for transgender women. Little is known about prostate cancer incidence or screening in this population. Additional research is needed to establish guidelines for screening in this population.

Keywords: Prostate cancer; Prostate cancer screening; Transgender; Transgender women.

Publication types

Meta-Analysis
Case Reports
Review

MeSH terms

Early Detection of Cancer
Humans
Male
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms* / diagnosis
Prostatic Neoplasms* / epidemiology
Transgender Persons*

Substances

Prostate-Specific Antigen