Comparison of prostate cancer characteristics in transgender females and cisgender males Open Access

Longhini, Kelly (Spring 2025)

Permanent URL: https://etd.library.emory.edu/concern/etds/9w032480m?locale=en
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Abstract

Background: The data on risk and outcomes of cancer, especially hormone-related malignancies, among transgender and gender diverse individuals are limited. The goal of this study was to compare prostate cancer (PCa) characteristics among transgender female (TF) and cisgender male (CM) patients using data from the Study of Transition, Outcomes and Gender (STRONG) nested within four large integrated health systems.

Methods: TF and CM members of the STRONG cohort diagnosed with PCa between 1991 and 2024 were included in this study. After excluding participants with a missing diagnosis date or a missing stage at diagnosis, the analysis dataset included 726 participants, 40 TF and 686 CM. Prostate specific antigen (PSA) levels and Gleason scores were compared between TF and CM using Wilcoxon rank sum tests. The proportions of non-localized (regional or distant) stage PCa were compared in TF and CM groups using a log-binomial model and a Poisson model with robust variance estimates with results expressed as adjusted prevalence ratios (PR) and the corresponding 95% confidence intervals (CI).

Results: The distributions of PSA levels and Gleason scores were similar among TF and CM patients with Wilcoxon rank sum test p-values of 0.28 and 0.36, respectively. The proportions of TF and CM patients with distant disease were 10% and 5%, respectively; however, these estimates were based on very small numbers. The prevalence of non-localized stage PCa was only slightly higher among TF compared to CM (Poisson model PR=1.08, 95% CI: 0.60, 1.95; log-binomial model PR=1.11, 95% CI: 0.62, 1.99) after controlling for study site, race, age at diagnosis, and years of diagnosis.

Conclusion: Whereas the present study showed no major differences between PCa characteristics in TF and CM groups, the results suggesting that TF patients are more likely to present with distant disease, require further investigation. This study demonstrates the feasibility to compare diagnostic and prognostic characteristics of PCa in TF and CM, and future studies should aim to include larger samples and details on gender affirming treatments.

Table of Contents

Introduction 1

Methods 4

Results 8

Discussion 10

References 13

Tables and Figures 18

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