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Matthew Loria on screening for prostate cancer in transgender women

Opinion
Video

“The main takeaway is that we want to be working with [transgender and gender-diverse patients] the same way that we are working with cisgender folks,” says Matthew Loria.

In this video, Matthew Loria discusses questions arising from the recent Prostate Cancer and Prostatic Diseases paper, “Incidence of prostate cancer in transgender women in the US: a large database analysis.” Loria is an MD student at Case Western Reserve University in Cleveland, Ohio.

Transcription:

What questions arise from this research?

I think the number 1 question that comes out of this is, we know the risk may be lower than cisgender men, but how do we implement this into clinical practice? Because there already is a lot of debate about prostate cancer screening and particularly PSA level cut-offs, and is PSA a good test to use anymore? So I think a lot of these qualms that we're trying to figure out in the cisgender male population also apply to the trans and gender-diverse population. Really, the main takeaway is that we want to be working with this population the same way that we are working with cisgender folks. We just need to be treating them equally and not that they're at any less risk than cis men...So I think future research really has to just look at solidifying, what does screening for prostate cancer look like, and are there any differences for this population? Because this is the first population that we're really going to be able to interact with and look at to see those that are on some sort of estrogen, like some sort of hormone therapy, but still have a prostate, what does that look like? Because we know prostate cancer tends to be a testosterone-sensitive cancer. So when we're adding in what is typically referred to as cross sex hormone therapy and having the presence of some level of testosterone, but now increasing levels of estrogen, what does that look like, particularly in the context of PSA screening? Is there going to be like a higher cut-off or a lower cutoff for transgender folks? What is that difference going to be so that we can most appropriately screen this population?I think that's what we're starting to think about. And I know there are a lot of other research groups that are starting to look into this question of, do we need to adjust this PSA screening level for this population to make sure that they're being adequately screened? And then second, I think from a more clinical perspective, it's for providers to continue to offer their patients this level of screening and to making sure that this population is getting their needs met. And so I think future research looks at how can we reduce barriers for trans folks to get this screening, and are there current barriers involved that we can address so that they can undergo appropriate screenings?

This transcription was edited for clarity.

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