Prostate Cancer in Male-to-Female Transgender Individuals: Histopathologic Findings and Association With...

Area of Science:

• Urology
• Pathology
• Endocrinology

Background:

• Male-to-female (MtF) transgender individuals are a population at risk for prostate cancer.
• Screening and management guidelines for prostate cancer in MtF transgender individuals are not well established.
• Hormone therapy for gender affirmation can induce histopathologic changes in prostate tissue.

Purpose of the Study:

• To describe histopathologic features of prostate tissue in MtF transgender patients.
• To highlight challenges in the pathologic interpretation of prostate cancer in this population.
• To assess the impact of hormone therapy on prostate cancer morphology and grading.

Main Methods:

• Retrospective review of prostate tissue samples from 9 MtF transgender patients.
• Histopathologic examination of benign and malignant prostate tissues.
• Correlation of histopathologic findings with clinical history, including hormone therapy use.

Main Results:

• Seven of 9 patients were diagnosed with prostate cancer, all with elevated prostate-specific antigen.
• Three patients with prostate cancer and 2 with benign tissue showed histopathologic evidence of hormone therapy effects.
• Hormone therapy induced changes in both benign prostate tissue (atrophy, hyperplasia) and cancer (nuclear pyknosis, altered architecture).
• Prostate cancer with hormone therapy effect may be subtle and prone to underrecognition or over-grading if not recognized by pathologists.

Conclusions:

• Hormone therapy for gender affirmation significantly alters prostate tissue morphology in MtF transgender individuals.
• Pathologists must be aware of these hormone-induced changes to accurately diagnose and grade prostate cancer.
• Accurate interpretation requires consideration of clinical history, particularly hormone therapy, to avoid misstaging and over-grading of prostate cancer.