Transgender ladies on hormone remedy are inclined to skew artificially low on prostate most cancers screening exams, which can give false reassurance and delay prognosis and therapy, reviews a brand new examine led by UC San Francisco.
The researchers discovered that transwomen scored 50 occasions decrease than typical PSA exams (prostate-specific antigen), the gold commonplace software to detect prostate most cancers. This might imply that present “regular” thresholds are too excessive for transgender ladies, and their most cancers may not be discovered till a later stage, the investigators stated.
The examine seems June 26 in JAMA.
It’s important to not lose sight of long-term most cancers dangers in retained organs.”
Transgender ladies hold their prostates following gender-affirming surgical procedure which places them in danger for prostate most cancers. Usually, they’re on estrogen, the commonest gender-affirming hormone. However sufferers taking estrogen usually tend to present up of their physician’s workplaces with high-grade prostate most cancers.
“Sufferers and clinicians ought to be conscious that PSA values in transgender ladies on estrogen ought to be interpreted with warning, as they’re totally different than these in cisgender males,” stated lead creator Farnoosh Nik-Ahd, MD, a resident on the UCSF Division of Urology.
The prostate, a small gland that helps make semen, produces a protein referred to as prostate-specific antigen, or PSA. Blood ranges of PSA continuously are elevated in individuals with prostate most cancers – and the PSA check, which measures these ranges, is often used as a screening software.
Within the new examine, investigators analyzed Veterans Well being Administration information between January 2000 and August 2023. Altogether, 210 sufferers who have been 40 and older, on estrogen and had no historical past of prostate most cancers have been included.
The researchers discovered that PSA ranges have been drastically decrease in transgender sufferers on estrogen and these sufferers may not get further screening till their PSA ranges rose, which might imply their cancers have been detected at a later stage.
At present, there are not any PSA ranges particular to transgender ladies. The researchers stated that additional work is required to find out the dangers and advantages of PSA screening amongst transgender ladies and to pinpoint ideally suited prostate most cancers screening practices for them.
“As an increasing number of transwomen have acceptable entry to gender-affirming care, it’s important to not lose sight of long-term most cancers dangers in retained organs,” stated co-senior creator Matthew R. Cooperberg, MD, MPH, a UCSF urology professor and co-leader of the prostate most cancers program on the UCSF Helen Diller Household Complete Most cancers Middle.
“We’re simply beginning to perceive how estrogen and associated therapies modulate prostate most cancers danger, and easy methods to interpret PSA values on this inhabitants, so we will evolve a rational and evidence-based screening coverage,” he stated.
Authors: Moreover Nik-Ahd and Cooperberg, authors from UCSF are Christi Butler, MD, and Peter R. Carroll, MD, MPH. Different authors are Amanda M. De Hoedt of the Veterans Affairs Care System, in Durham, North Carolina; Jennifer T. Anger, of UC San Diego; and co-senior creator Stephen J. Freedland, MD, with the VA in Durham, NC, and Cedars-Sinai Medical Middle.
Funding: The analysis was supported by the Nationwide Institute on Growing older (grant quantity R38AG07017), the 2023 Urology Care Basis Residency Analysis Award Program, and the Robert J. Krane, MD, Urology Analysis Fund.
Disclosures: Cooperberg reviews private charges from Janssen, Astra Zeneca, Astellas, Pfizer, Bayer, Verana Well being, Veracyte, LynxDx, ExoDx, and Merck.
