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Epidemiology

Prostate cancer in transgender women: considerations for screening, diagnosis and management

British Journal of Cancer volume 128, pages 177–189 (2023)Cite this article

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Abstract

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.

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Fig. 1: Impact of feminising therapies on the prostate.
Fig. 2: Proposed approach to prostate cancer screening in transgender women.
Fig. 3: MRI sagittal view from the pelvis of a transgender woman post gender-confirming surgery.

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Authors and Affiliations

  1. Internal Medicine, Mount Sinai Morningside West, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Fionnuala Crowley

  2. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Meredith Mihalopoulos, Simita Gaglani, Ashutosh K. Tewari, Miroslav Djordjevic, Natasha Kyprianou, Rajveer S. Purohit & Dara J. Lundon

  3. Department of Medicine, Division of Hematology/Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Che-Kai Tsao

  4. Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Che-Kai Tsao & Natasha Kyprianou

  5. Department of Pathology & Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Natasha Kyprianou

  6. Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Natasha Kyprianou

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  1. Fionnuala Crowley
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Contributions

The manuscript was conceptualised and designed by NK, RSP and DJL. Literature review was performed by FC, MM, SG and DJL. Tables and figures were prepared by FC, MM, SG and DJL. FC, MM, SG, NK and DJL wrote and prepared the initial draft. AKT, CT, MD, NK, RSJ and DJL reviewed, edited and revised the manuscript at all points. All authors read and approved the final version of the manuscript. Figure 1 was created with BioRender.com.

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Correspondence to Rajveer S. Purohit or Dara J. Lundon.

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AKT certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received or pending), are the following: AKT has served as a site PI on pharma/industry-sponsored clinical trials from Kite Pharma Inc., Lumicell, Inc., Dendron Pharmaceuticals, LLC, Oncovir Inc., Blue Earth Diagnostics Ltd., RhoVac ApS., Bayer HealthCare Pharmaceuticals Inc., and Janssen Research and Development, LLC; has received research funding (grants) to his institution from DOD, NIH, Axogen, Intuitive Surgical, AMBF and other philanthropy; has served as an unpaid consultant to Roivant Biosciences and advisor to Promaxo; and owns equity in Promaxo. The remaining authors declare no competing interests in relation to the work described.

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Crowley, F., Mihalopoulos, M., Gaglani, S. et al. Prostate cancer in transgender women: considerations for screening, diagnosis and management. Br J Cancer 128, 177–189 (2023). https://doi.org/10.1038/s41416-022-01989-y

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