A recent study cautions that transgender women may not be screened for early-stage prostate cancer due to current screening guidelines.
Prostate-specific antigen (PSA), a protein made by the tiny gland, is the target of tests for prostate cancer. Prostate cancer patients typically have higher blood PSA levels.
However, senior researcher Dr. Stephen Freedland, chair of prostate cancer at Cedars-Sinai Medical Center in Los Angeles, noted that the estrogen that many transgender women take as part of their gender-affirming care “drastically lowers PSA levels, which could mean the threshold we are using as ‘normal’ is too high to detect early-stage cancer in these patients.”
According to current guidelines, a PSA level of more than 4 nanograms per milliliter of blood may indicate the presence of cancer.
A prostate biopsy may be prescribed at certain levels in order to screen for malignancy.
Researchers examined the medical records of 210 transgender women who were taking estrogen but did not have prostate cancer from the Veterans Health Administration for this study, which was published on June 26 in the Journal of the American Medical Association.
Lead researcher Dr. Farnoosh Nik-Ahd, a urology resident at the University of California, San Francisco, stated, “We found that the median PSA value, the midpoint in the range of participants, was 0.02 ng/mL, which is fiftyfold lower than PSA values reported in similar-aged cisgender men.”
Accordingly, Nik-Ahd clarified that transsexual women using estrogen who acquire prostate cancer are unlikely to detect an increase in PSA high enough to warrant a biopsy, at least not until the cancer has progressed.
Prostate cancer will then pose a greater risk to life and be more challenging to treat.
According to Freedland, more investigation is required to identify the precise PSA values that suggest a transgender woman on estrogen is more likely to develop prostate cancer.
However, Freedland pointed out that the study does not advocate for screening all transgender women.
According to a Cedars Sinai news release, Freedland stated, “We know that PSA screening reduces the risk that cisgender men ages 55 to 69 will die of prostate cancer, but we don’t know that it does the same thing for transgender women taking estrogen.”
However, we want to bring attention to the fact that some of these women are undergoing screening; therefore, their typical PSA levels are different.
Freedland suggests transgender women on estrogen speak with their physicians in the interim.
Freedland advised, “Remember that you have a prostate and that prostate can develop cancer.” “A PSA test is the best method we know of to detect those cancers early and lower the risk of death.” Additionally, bear in mind that the test results will not be adjusted for you if you decide to do that.
“Take this study and your results to your urologist so that someone who knows what to do with that information can interpret your results,” said Freedland.
