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Commentary of a New Study of Prostate Cancer Incidence in Transfeminine People Receiving Hormone Therapy

By Sam S. | First published July 9, 2020 | Last modified May 17, 2021

Link to Article

de Nie, I., de Blok, C. J., van der Sluis, T. M., Barbé, E., Pigot, G. L., Wiepjes, C. M., … & den Heijer, M. (2020). Prostate cancer incidence under androgen deprivation: nationwide cohort study in trans women receiving hormone treatment. The Journal of Clinical Endocrinology & Metabolism, 105(9).

[DOI: 10.1210/clinem/dgaa412]

Summary and Discussion

This is a new nationwide retrospective cohort study of prostate cancer incidence in 2,281 transgender people receiving feminising hormone therapy in the Netherlands for a total follow-up time of 37,117 patient years. Previously, not a great deal has been known about prostate cancer incidence in transfeminine people. This is because past studies have been restricted by their small sample sizes and low number of follow-up years or by limitations in their methodology and therefore have had poor statistical power. Additionally, some studies have included transgender people who were not receiving gender-affirming hormone therapy in their samples, so it’s not possible to extrapolate these data to those of who do take hormone therapy (eg: Gooren & Morgentaler.,2014; Silverberg et al.,2017). This new study is free of both these limitations.

The analyses were performed by clinicians and researchers at the VU University Medical Center (or VUMC) in Amsterdam. In summary, their study shows approximately a 5-fold significant decrease [SIR: 0.20 (95% CI: 0.08–0.42)] in prostate cancer incidence in hormone treated participants relative to the general male population of the same age. Therefore, these data appear to confirm a protective effect of androgen deprivation and gender-affirming hormone therapy against prostate carcinoma. I feel this excerpt from the discussion section is especially relevant:

European guidelines advice against systematic population-based PSA screening for prostate cancer, since it does not increase survival and causes overtreatment.29 Following these guidelines, routine population-based PSA screening, in both cis men and trans women, is not performed in the Netherlands. PSA testing is only recommended in people with an elevated risk of prostate cancer after counselling on the potential risks and benefits.30 Given the low incidence of prostate cancer and lack of PSA reference values in this population, there is even less reason to perform routine screening in trans women. However, it remains important that trans women and their health care providers are aware of the presence of the prostate and the possibility of the development of prostate cancer despite low serum androgen levels.

You can read the full paper at the link above.