Matthew R. Cooperberg, MD, MPH
Transgender girls on hormone remedy are likely to skew artificially low on prostate most cancers screening assessments, which can give false reassurance and delay prognosis and remedy, stories a brand new examine led by UC San Francisco.
The researchers discovered that transwomen scored 50 instances decrease than typical PSA assessments (prostate-specific antigen), the gold commonplace software to detect prostate most cancers. This might imply that present “regular” thresholds are too excessive for transgender girls, and their most cancers won’t be discovered till a later stage, the investigators mentioned.
The examine seems June 26 in JAMA.
Transgender girls hold their prostates following gender-affirming surgical procedure which places them in danger for prostate most cancers. Typically, they’re on estrogen, the most typical 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 must be conscious that PSA values in transgender girls on estrogen must be interpreted with warning, as they’re completely different than these in cisgender males,” mentioned lead writer Farnoosh Nik-Ahd, MD, a resident on the UCSF Division of Urology.
The prostate, a small gland that helps make semen, produces a protein known as prostate-specific antigen, or PSA. Blood ranges of PSA often are elevated in folks 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 data 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 won’t get extra 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 girls. The researchers mentioned that additional work is required to find out the dangers and advantages of PSA screening amongst transgender girls and to pinpoint ideally suited prostate most cancers screening practices for them.
“As increasingly more transwomen have acceptable entry to gender-affirming care, it’s vital to not lose sight of long-term most cancers dangers in retained organs,” mentioned co-senior writer 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 Heart.
“We’re simply beginning to perceive how estrogen and associated therapies modulate prostate most cancers danger, and find out how to interpret PSA values on this inhabitants, so we will evolve a rational and evidence-based screening coverage,” he mentioned.
Authors: In addition to 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 writer Stephen J. Freedland, MD, with the VA in Durham, NC, and Cedars-Sinai Medical Heart.
Funding: The analysis was supported by the Nationwide Institute on Ageing (grant quantity R38AG07017), the 2023 Urology Care Basis Residency Analysis Award Program, and the Robert J. Krane, MD, Urology Analysis Fund.
Disclosures: Cooperberg stories private charges from Janssen, Astra Zeneca, Astellas, Pfizer, Bayer, Verana Well being, Veracyte, LynxDx, ExoDx, and Merck.
