(036) Understanding Prostate Cancer Disparities in Transgender Women: A Scoping ReviewS Irani, L Zebib
- Reproductive Medicine
- Endocrinology, Diabetes and Metabolism
- Psychiatry and Mental health
Prostate cancer is a significant driver of morbidity and mortality in the United States, with growing awareness of the unique challenges of navigating the diagnosis in transgender/non-binary patients. Current evidence shows that although prostate cancer in transgender women is a relatively rare occurrence, it often involves a significant disease burden. As in many diagnoses, gender minorities may face significant barriers in accessing urological care including fear of stigmatization of gender identity by medical personnel and institutions. Although urologists will need to provide unique counseling to this marginalized group, there remains little understanding of the experience of prostate cancer within the transgender/non-binary community.
To provide an overview of the current literature on disparities transgender individuals face in accessing care for prostate cancer, to identify gaps in the existing literature, and to provide a framework for urologists to best address gender minorities.
A scoping review was undertaken according to the PRISMA Extension for Scoping Reviews Checklist. Searches were conducted in PubMed, Scopus, LGBTQ+ Source, and EMBASE. Search terms included “prostate cancer,” “prostate specific antigen,” “transgender persons,” “sexual minorities,” “non-binary individuals,” and “transgender women,”. Articles were included if they discussed the experience of prostate cancer in transgender patients and information sharing, screening, and treatment of prostate cancer in transgender women. Articles were excluded if they did not specifically pertain to prostate cancer or included all LGBTQ+ identities.
A total of 871 titles and abstracts were screened by two independent reviewers. 128 full-text studies were reviewed, with 42 eligible for inclusion. The included studies encompassed several themes, including descriptions of the epidemiology of prostate cancer in transgender women, current recommendations for screening and treatment, and how physicians can offer appropriate and compassionate care to transgender women.
The current literature on the barriers transgender women face in obtaining prostate cancer screening is characterized. Given the use of hormone therapy, transgender women are at significantly lower risk of prostate cancer when compared to cis-gender men. However, there are many documented cases of prostate cancer in transgender women. Although there are no current screening recommendations, the literature supports physicians engaging in shared decision making with their patients to agree on acceptable prostate cancer screening. Further studies should be aimed at characterizing transgender women’s experiences with and desires for prostate cancer.