Prostate cancer screening in transgender patients: what evidence do we have?

INTRODUCTION: Transgender women (TW) are individuals who were assigned male at birth based on their biological attributes, yet identify as female. In order to successfully transition from male to female, TW may opt to undergo gender-affirming hormone treatment (GAHT) and gender-affirming surgery (GAS). The risk for developing prostate cancer (PC) in this population persists as long as the organ remains in situ, however its occurrence is still a matter of debate, as data from epidemiological studies is limited and inconclusive. Nevertheless, as a result of inadequate screening protocols among these particular demographics, the true prevalence may be greater than previously suggested.EVIDENCE ACQUISITION: As of July 2024, 30 studies investigating the prevalence of PC in TW have been published, highlighting it as a relatively unexplored and yet emerging healthcare issue. No meta-analyses or randomized control trials were available.EVIDENCE SYNTHESIS: The lack of specific screening criteria for PC, the uncertain impact of GAHT on PC risk, changes to pelvic anatomy after GAS, and challenges in healthcare access of this demographic can lead to inefficiencies in cancer identification and treatment. Nevertheless, there is an urgent need for cancer screening and prevention programs that explicitly target the unique anatomy and high-risk behaviors of this population.CONCLUSIONS: Understanding this complex and sensitive healthcare challenge is crucial for physicians to tailor efficient screening techniques and individualized treatment strategies, as well as engage in collaborative decision-making.