TY - JOUR
T1 - Prostate cancer in transgender women
T2 - considerations for screening, diagnosis and management
AU - Crowley, Fionnuala
AU - Mihalopoulos, Meredith
AU - Gaglani, Simita
AU - Tewari, Ashutosh K.
AU - Tsao, Che Kai
AU - Djordjevic, Miroslav
AU - Kyprianou, Natasha
AU - Purohit, Rajveer S.
AU - Lundon, Dara J.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2023/1/19
Y1 - 2023/1/19
N2 - Transgender individuals represent 0.55% of the US population, equivalent to 1.4 million transgender adults. In transgender women, feminisation can include a number of medical and surgical interventions. The main goal is to deprive the phenotypically masculine body of androgens and simultaneously provide oestrogen therapy for feminisation. In gender-confirming surgery (GCS) for transgender females, the prostate is usually not removed. Due to limitations of existing cohort studies, the true incidence of prostate cancer in transgender females is unknown but is thought to be less than the incidence among cis-gender males. It is unclear how prostate cancer develops in androgen-deprived conditions in these patients. Six out of eleven case reports in the literature presented with metastatic disease. It is thought that androgen receptor-mediated mechanisms or tumour-promoting effects of oestrogen may be responsible. Due to the low incidence of prostate cancer identified in transgender women, there is little evidence to drive specific screening recommendations in this patient subpopulation. The treatment of early and locally advanced prostate cancer in these patients warrants an individualised thoughtful approach with input from patients’ reconstructive surgeons. Both surgical and radiation treatment for prostate cancer in these patients can profoundly impact the patient’s quality of life. In this review, we discuss the evidence surrounding screening and treatment of prostate cancer in transgender women and consider the current gaps in our knowledge in providing evidence-based guidance at the molecular, genomic and epidemiological level, for clinical decision-making in the management of these patients.
AB - Transgender individuals represent 0.55% of the US population, equivalent to 1.4 million transgender adults. In transgender women, feminisation can include a number of medical and surgical interventions. The main goal is to deprive the phenotypically masculine body of androgens and simultaneously provide oestrogen therapy for feminisation. In gender-confirming surgery (GCS) for transgender females, the prostate is usually not removed. Due to limitations of existing cohort studies, the true incidence of prostate cancer in transgender females is unknown but is thought to be less than the incidence among cis-gender males. It is unclear how prostate cancer develops in androgen-deprived conditions in these patients. Six out of eleven case reports in the literature presented with metastatic disease. It is thought that androgen receptor-mediated mechanisms or tumour-promoting effects of oestrogen may be responsible. Due to the low incidence of prostate cancer identified in transgender women, there is little evidence to drive specific screening recommendations in this patient subpopulation. The treatment of early and locally advanced prostate cancer in these patients warrants an individualised thoughtful approach with input from patients’ reconstructive surgeons. Both surgical and radiation treatment for prostate cancer in these patients can profoundly impact the patient’s quality of life. In this review, we discuss the evidence surrounding screening and treatment of prostate cancer in transgender women and consider the current gaps in our knowledge in providing evidence-based guidance at the molecular, genomic and epidemiological level, for clinical decision-making in the management of these patients.
UR - http://www.scopus.com/inward/record.url?scp=85140133155&partnerID=8YFLogxK
U2 - 10.1038/s41416-022-01989-y
DO - 10.1038/s41416-022-01989-y
M3 - Review article
AN - SCOPUS:85140133155
SN - 0007-0920
VL - 128
SP - 177
EP - 189
JO - British Journal of Cancer
JF - British Journal of Cancer
IS - 2
ER -