PSA May Be Insufficient to Detect Early Prostate Cancer in Transgender Women (ascopost.com)

submitted 4 months ago by StevenSaus@midwest.social to c/lgbtq_plus@beehaw.org

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Transgender women receiving hormone therapy may skew artificially low on prostate cancer screening tests, thereby providing false reassurance and potentially delaying diagnosis and treatment, according to a recent study published by Nik-Ahd et al in JAMA. The findings indicated that transgender women and physicians should interpret standard screening guidelines with caution.

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[-] ada@lemmy.blahaj.zone 10 points 4 months ago* (last edited 4 months ago)

The opening sentence of that journal article feels off...

"Among people with prostate cancer, transgender women receiving estrogen are more likely to present with high-grade disease vs cisgender men, suggesting potential delayed diagnosis"

Given that trans women have smaller prostates (a protective factor) and lower testosterone (a protective factor) and that estrogen therapy is the leading treatment for men with prostate cancer, it feels like quite an assumption to state that lower overall presentations of high grade cancer are potentially an indication of an increased risk of high grade cancer...

[-] StevenSaus@midwest.social 8 points 4 months ago

I believe their logic is such (I'm not involved with the study, but have a background in medicine and research):

Elevated PSA (a blood test) signals prostate cancers.
PSA tests are relatively routine bloodwork with an assumption of uniform coverage across all patients, trans or not. PSA tests are presumed to uncover early cancer presentation. Therefore, if we're only seeing advanced cancer presentation in trans women, the PSA test is a poor screening device for early prostate cancer in that population.

Point 2 is a big assumption; I am ignorant if that would be a confounding variable in real life, or if that's even been studied.

[-] ada@lemmy.blahaj.zone 5 points 4 months ago

All I've got is anecdotes, but as I understand it, trans women are less likely to get prostate cancer in the first place. Personally, I don't know any trans women that have prostate cancer, and given how many older trans women I know, that suggests it's less common than you'd expect in cis men.

However, it could fit that those of us who do get prostate cancer are at a more severe level before it's detected. In my years in the trans community, the only times I've learned of trans women with prostate cancer is when it's been advanced. But those are all second hand stories and blogs/news articles etc.