(117) PROSTATE CANCER SCREENING IN TRANSGENDER WOMEN: A SCOPING REVIEW
Authors: Borges Cabral Junior J , Antonio De Souza Filho C , Regis De Carvalho Carneiro G , Peixoto De Siqueira De Lemos Lins V , Ferreira De Castro Neto J , Emanuelly De Macedo Barros I , Simoes Inacio Cavalcanti S , Mendonça De Godoy F , Lucas Silverio Bezerra Santos P , Camara De Andrade Viana L , Henrique Teotonio Medeiros Peixoto P 
Published: December 2024

Introduction

Prostate cancer screening in transgender women is an emerging and underexplored topic in medical literature. With increased visibility and recognition of the specific health needs of this population, understanding the risks and challenges associated with prostate cancer in transgender women is crucial. The prostate, which remains intact during gender-affirming surgery, can develop malignancies, needing appropriate screening protocols. This scoping review aims to consolidate existing evidence on the incidence, clinical characteristics, and management of prostate cancer in transgender women, identify barriers to screening, and propose recommendations for improving early detection and oncological care.

Objective

This scoping review aims to map existing literature on prostate cancer screening in transgender women, evaluating current practices, efficacy, barriers, and facilitators.

Methods

The methodology for this scoping review followed the PRISMA model, encompassing identification, screening, eligibility, and inclusion stages. Searches were conducted in the MEDLINE, Biblioteca Virtual em Saúde (BVS), and LIVIVO databases using the search strategy: (prostate cancer) AND (transgender persons OR transgender women) AND (screening). Without a specified time frame, 63 articles were initially found. After removing 24 duplicates, 39 articles remained. Of these, 22 were excluded: 8 did not address prostate cancer, 8 did not discuss screening, 4 were inaccessible, and 1 did not focus on transgender women.

Results

The literature on prostate cancer (CaP) in transgender women (TGW) reveals a low but significant incidence. One study identified 10 cases, highlighting the need for screening similar to that for cisgender men, as estrogen therapy may not be protective. Another study reported a median incidence of CaP in TGW of 44.1 cases per 100 000 person-years, with a higher mortality risk post-diagnosis. The reduced incidence might be due to the atrophying effect of estrogen on the prostate. Gender-affirming hormone therapy (GAHT) induces histological changes in both benign and malignant prostate tissues, complicating cancer evaluation. CaP management in TGW should be individualized, considering the patient’s hormonal and surgical history. PSA screening rates in TGW are lower than in cisgender men, even after adjusting for medical visits, suggesting the influence of hormone therapy duration and type. Awareness of CaP risk is crucial for TGW post-gender-affirming surgery, underscoring the need for better information and communication from surgeons. The lack of specific screening guidelines and the importance of holistic management were highlighted to mitigate the impact on quality of life. Hormone therapy might have a protective effect in reducing CaP incidence in TGW aged 50 to 64. However, there is no consensus on PSA screening in TGW, indicating a need for clinical guidelines to improve healthcare for this population.

Conclusions

These results underscore the urgent need for longitudinal studies and specific guidelines to optimize the diagnosis and treatment of CaP in TGW. Future studies should focus on establishing appropriate baseline PSA values, determining the right timing to initiate screening, and improving biomarker accuracy in TGW undergoing hormone therapy. Additionally, healthcare professionals must be well-informed and trained to meet the specific needs of this population, considering both medical and psychosocial aspects of CaP management in TGW.

Disclosure

No.