Prostate Cancer in Transgender Women: Incidence, Etiopathogenesis, and Management Challenges

Objective To critically analyze the available evidence regarding the incidence, etiopathogenesis, and management of prostate cancer (CaP) in transgender women. In addition, this article aims to present a recent case report of a transgender woman with a unique presentation at the author's institution. Materials and Methods An electronic nonsystematic literature search was performed to identify pertinent studies. PubMed search engine was queried by using the following search terms: “prostate cancer,” “male to female transsexual,” “transgender patient,” “androgen + prostate cancer,” “estrogen therapy + prostate cancer,” and “health care barrier.” In addition, a clinical case managed at our institution was reviewed and critically discussed. Results Including our case, there have been only 10 documented cases of CaP in transgender women. Additionally, an emerging body of literature has questioned the role of androgens in the development of CaP and suggested that estrogen therapy may not be as protective as initially thought. Therefore, the current evidence suggests that the transgender woman should be screened for CaP the same as a nontransgender men. Barriers to care in the transgender female population include accessing resources, medical knowledge deficits, ethics of transition-related medical care, diagnosing vs pathologizing transgender patients, financial restrictions of the patient, and health system determinants. Conclusion Although rare, CaP in transgender women has been documented. Both the mechanism and the impact of receiving a bilateral orchiectomy on disease development are unclear. Future study is needed to examine these factors, and to further shape the treatment and screening regimen for these patients.