Publications

Addressing Histopathologic Challenges: Prostate Cancer in the Transgender Population

We studied a cohort of male-to-female transgender patients diagnosed with prostate cancer. The study demonstrates several important issues unique to this population. First, we demonstrate that prostate cancer, including lethal disease, may arise in transgender individuals on long-term hormone therapy for gender affirmation. Therefore, prostate cancer screening should be considered in transgender patients regardless of hormone therapy although customized PSA thresholds and the ideal modality for screening require further study, as hormone therapy for gender affirmation is known to lower the serum PSA. Second, by studying the histologic features of the cohort, we demonstrate that hormone therapy for gender affirmation alters the morphology of both benign prostate tissue and prostatic adenocarcinoma in a manner analogous to androgen deprivation therapy given to cis-men for prostate cancer. Thus, in transgender patients on hormone therapy for gender affirmation, care should be taken not to assign a Gleason score to prostatic adenocarcinoma in the setting of morphologic changes of hypo-androgenism because doing so would overstate the biological aggressiveness of the tumor.