Manfredi Celeste, Franco Antonio, Ditonno Francesco, Bologna Eugenio, Licari Leslie Claire, Leonardo Costantino, Antonelli Alessandro, De Nunzio Cosimo, Cherullo Edward E, De Sio Marco, Autorino Riccardo
Department of Urology, Rush University Medical Center, Chicago, Illinois.
Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli," Naples, Italy.
JAMA Oncol. 2024 Dec 1;10(12):1697-1700. doi: 10.1001/jamaoncol.2024.4335.
Evidence on prostate cancer (PCa) in transgender women is very limited; data are needed to reduce gender disparities in both PCa knowledge and health care.
To evaluate the prevalence of PCa among transgender women in the US and assess the factors associated with PCa, and factors associated with biochemical recurrence (BCR) and bone metastases (BM) secondary to PCa in the transgender population.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted in October 2023, covering the period between 2011 and 2022 (12-year analysis). The study was based on a large, all-payer claims, deidentified, US database (PearlDiver Mariner). Transgender women who were identified as male before assignment of transsexual status codes were included. Patients with PCa were detected in the transgender women population.
PCa diagnosis was selected as primary outcome; BCR and BM were chosen as secondary outcomes.
A total of 95 460 transgender women with a mean (SD) age of 52.5 (9.4) years were included. PCa was diagnosed in 589 individuals with a mean (SD) age of 66.8 (10.0) years (estimated prevalence, 0.62%; 95% CI, 0.54%-0.77%). Age (adjusted odds ratio [OR], 1.10; 95% CI, 1.08-1.12; P < .001) and family history (adjusted OR, 2.27; 95% CI, 1.60-4.92; P < .001) were positively associated with PCa in transgender women. Gender-affirming hormone therapy (GAHT) was negatively associated with PCa in transgender women (OR, 0.60; 95% CI, 0.56-0.89; P < .001) but positively associated with BCR (OR, 1.83; 95% CI, 1.21-2.86; P < .001) and BM (OR, 3.96; 95% CI, 1.50-9.99; P < .001) in the transgender population with PCa.
This cohort study found that PCa appeared to be relatively uncommon in transgender women. GAHT may reduce the risk of PCa in transgender patients, but it may also increase the risk of BCR and BM in transgender women with PCa. Further studies are needed to confirm our findings.
关于变性女性患前列腺癌（PCa）的证据非常有限；需要数据来减少PCa知识和医疗保健方面的性别差异。
评估美国变性女性中PCa的患病率，评估与PCa相关的因素，以及与变性人群中PCa继发的生化复发（BCR）和骨转移（BM）相关的因素。
设计、设置和参与者：2023年10月进行了一项回顾性队列研究，涵盖2011年至2022年期间（12年分析）。该研究基于一个大型的、所有付款人索赔的、去识别化的美国数据库（PearlDiver Mariner）。纳入了在分配变性状态代码之前被识别为男性的变性女性。在变性女性人群中检测到患有PCa的患者。
PCa诊断被选为主要结局；BCR和BM被选为次要结局。
共纳入95460名变性女性，平均（标准差）年龄为52.5（9.4）岁。589人被诊断为PCa，平均（标准差）年龄为66.8（10.0）岁（估计患病率为0.62%；95%置信区间为0.54%-0.77%）。年龄（调整后的优势比[OR]为1.10；95%置信区间为1.08-1.12；P < .001）和家族史（调整后的OR为2.27；95%置信区间为1.60-4.92；P < .001）与变性女性的PCa呈正相关。性别确认激素治疗（GAHT）与变性女性的PCa呈负相关（OR为0.60；95%置信区间为0.56-0.89；P < .001），但与患有PCa的变性人群中的BCR（OR为1.83；95%置信区间为1.21-2.86；P < .001）和BM（OR为3.96；95%置信区间为1.50-9.99；P < .001）呈正相关。
这项队列研究发现，PCa在变性女性中似乎相对不常见。GAHT可能会降低变性患者患PCa的风险，但也可能增加患有PCa的变性女性发生BCR和BM的风险。需要进一步的研究来证实我们的发现。
