Mp34-01 Baseline Prostate-Specific Antigen Screening Values in Transgender Women on Gender-Affirming Hormone Therapy: A National Cohort Study

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes II (MP34)1 May 2024MP34-01 BASELINE PROSTATE-SPECIFIC ANTIGEN SCREENING VALUES IN TRANSGENDER WOMEN ON GENDER-AFFIRMING HORMONE THERAPY: A NATIONAL COHORT STUDY Farnoosh Nik-Ahd, Amanda de Hoedt, Christi Butler, Jennifer T. Anger, Peter R. Carroll, Matthew R. Cooperberg, and Stephen J. Freedland Farnoosh Nik-AhdFarnoosh Nik-Ahd , Amanda de HoedtAmanda de Hoedt , Christi ButlerChristi Butler , Jennifer T. AngerJennifer T. Anger , Peter R. CarrollPeter R. Carroll , Matthew R. CooperbergMatthew R. Cooperberg , and Stephen J. FreedlandStephen J. Freedland View All Author Informationhttps://doi.org/10.1097/01.JU.0001008876.78012.90.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transgender women (assigned male at birth) remain at risk of prostate cancer regardless of gender-affirmation surgery status, and thus should still be considered for prostate cancer screening. In a large VA-wide study of transgender women with prostate cancer, we found those on estrogen had the highest proportion of Grade Group 5 disease and the highest PSA density, both indicative of more aggressive disease and possibly delayed diagnosis. Though there are several potential reasons for possible delays in diagnosis, one possible explanation is that historic PSA reference ranges, set based on cisgender men, are not appropriate in transgender women on gender-affirming hormone therapy (GAHT). We explored baseline screening PSA values in transgender women on GAHT. METHODS: This is a retrospective study of patients ages 18 and older across the entire Veterans Health Administration (VHA) in the United States from January 2000-August 2023 with at least one ICD code related to transgender identity and without an ICD code for prostate cancer. Analysis was limited to patients on estrogen and spironolactone, the most common form of GAHT used. Detailed chart review was performed on 600 randomly selected patients to confirm transgender identity, continuous GAHT use for at least 6 months, lack of prostate cancer diagnosis or bilateral orchiectomy, and all screening PSA values when the patient was between 40-80 years. Median PSA and age at PSA test were calculated per patient and all PSA test results were stratified by decade of life. RESULTS: In total, 52 transgender women met inclusion criteria. Median age was 56 years and 87% were White (6% Black). Patients were on GAHT for a median of 97 months. Median PSA across all ages was 0.18 ng/mL. After stratifying all PSA tests by decade of life, median PSA was 0.20 ng/mL among those 40-49 years (N=26), 0.12 ng/mL for those 50-59 (N=58), 0.11 ng/mL among those 60-69 (N=69), and 0.10 ng/mL among those 70-80 (N=13). Of all PSA tests, only 43 (26%) showed a PSA >0.5 ng/ml and 15 (8%) showed a PSA >1.0 ng/mL. CONCLUSIONS: This is the first study describing baseline screening PSA values in transgender women on GAHT. Overall, across all decades, screening PSA values were far lower in transgender women on GAHT compared to values previously observed in cisgender men. Indeed, few PSA tests were ever >1.0 ng/mL. These data suggest that historic cisgender PSA references ranges may be far too high for transgender women on GAHT and may result in false reassurance and missed prostate cancer diagnoses. Future studies are needed to establish specific guidance on PSA interpretation in transgender women on GAHT, particularly as more individuals openly identify as transgender. Source of Funding: R38AG070171 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e570 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Farnoosh Nik-Ahd More articles by this author Amanda de Hoedt More articles by this author Christi Butler More articles by this author Jennifer T. Anger More articles by this author Peter R. Carroll More articles by this author Matthew R. Cooperberg More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...