Prostate Cancer Risk, Detection, and Outcomes in Transgender and Gender-Nonconforming Adults
Abstract
The number of transgender individuals in the U.S. has grown significantly in the past few decades. Specifically within the Veteran population, transgender-related diagnoses are 5 times more prevalent than in the general population. Because of widespread stigma associated with gender nonconformity, many transgender and gender non-binary individuals live on the margins of society and face discrimination, exclusion, and violence. They often have difficulties accessing appropriate health care, including both care specific to their gender needs and general medical care. They also face mistreatment in the health care system, leading them to avoid it entirely. As a result, they experience poor health compared to cisgender people. One very common treatment option is feminization or masculinization of the body through hormone therapy, which is effective in alleviating gender dysphoria, the discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth. Despite widespread hormonal use, it remains unknown whether hormone therapy in transgender individuals impacts the incidence of hormone-sensitive cancers, specifically prostate cancer in transgender women (assigned male at birth, living as women). Prostate cancer can produce higher amounts of prostate-specific antigen (PSA) than normal prostate tissue. Therefore, elevated PSA levels in the blood are an indicator of possible prostate cancer and the need for referral to a urologist for further evaluation. Patients diagnosed with prostate cancer via PSA testing (vs. physical exam) have better survival due to the early detection of aggressive disease and improved therapies. Given the impact of hormonal therapy on PSA values in men with prostate cancer, it is likely that the levels to define abnormal PSA in transgender women on feminizing hormones are much lower than in cisgender men. Despite the growing transgender population, normal PSA values for transgender women remain unknown and there are no formal guidelines on optimal prostate cancer screening practices for transgender women. Survival after a prostate cancer diagnosis has been shown to be worse among transgender individuals. It is not known whether this disparity is due to biological differences in the disease that could be related to hormone therapy or due to barriers to care for transgender patients (i.e., ongoing stigma and discrimination, patient denial about undergoing screening or treatment for a male cancer, and patient/clinician awareness of prostate cancer risk). We hypothesize that prostate cancer is underdiagnosed in this population, but this disparity can be reduced by establishing transgender-specific PSA screening guidelines and improving our understanding of the unique barriers to care and discrimination that transgender patients face. This study looks to improve the detection of prostate cancer in transgender women who suffer from worse health outcomes compared to their cisgender counterparts. Firstly, the study will quantify current disparities in cancer screening by looking at rates of PSA screening in transgender women compared to cisgender men. It will also improve detection by establishing normal PSA values for transgender women since current normal values are only based on cisgender men and determine the relationship between hormone levels and PSA values in transgender women. Lastly, we seek to understand attitudes about prostate cancer screening and care among transgender Veterans, identify barriers to care and sources of discrimination, and propose potential solutions through interviews with transgender women with a history of prostate cancer. Current guidelines for prostate cancer are based on studies of cisgender men and fail to fully encompass the nuanced biology and challenges of care of transgender women necessary to optimize health outcomes in this population. This study seeks to fill fundamental
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310419
Entities
People
- Jennifer Anger
Organizations
- United States Army
- University of California, San Diego