Prostate-specific antigen screening among transgender women in clinical care: A retrospective chart review study

Prostate-specific antigen (PSA) screening is controversial due to over-detection and treatment of low-grade prostate cancer. Consequently, the Canadian Urological Association (CUA) and the Canadian Task Force on Preventive Health Care (CTFPHC) differ with respect to recommending for versus recommending against PSA screening. Regardless, Canadian and global guidelines recommending PSA screening fail to address transgender (trans) women/transfeminine persons, though studies suggest this population remains at risk of prostate cancer, particularly those who have not accessed gender-affirming hormone therapy (GAHT) or gender-affirming surgeries. The objectives of this study were to: (1) characterize the prevalence of trans women/transfeminine persons aged 50+ who have ever received PSA screening and (2) explore sociodemographic, clinical, and social/structural factors associated with ever receiving PSA screening.

Drawing on a sub-sample of retrospective chart review data from trans women/ transfeminine persons aged 50+ across 6 family medicine and/or HIV clinics in Montreal and Toronto, Canada, 2018 to 2019 (excluding 1 endocrinology-only clinic), we assessed the prevalence of having received PSA screening (ever vs. never). Then, we compared ever having received PSA screening across sociodemographic (e.g., age), clinical (e.g., feminizing hormone therapy use), and social/structural factors (e.g., employment) using bivariable and multivariable binary logistic regression analyses.

Among trans women/transfeminine persons aged 50+ (n= 213), 23.0% had ever received PSA screening (95% CI: 17.5%-29.3%). Applying logistic regression, being HIV positive (compared to being HIV negative) was statistically significantly associated with ever having received PSA screening in both bivariable (OR: 3.0, 95% CI: 1.10, 8.19, P< 0.05) and multivariable analyses controlling for age (OR: 3.61, 95% CI: 1.28, 10.19, P< 0.05). Compared to not having had vaginoplasty and controlling for age, having had vaginoplasty trended towards lower odds of ever having received PSA screening (OR: 0.43, 95% CI: 0.17, 1.06, P= 0.066).

Findings suggest that most trans women/transfeminine persons aged 50+ in our sample had never received PSA screening. Future studies could explore trans women/transfeminine person patient-provider decision-making with respect to PSA screening. Findings reinforce the need for continued discussion of trans women/transfeminine persons' risk of prostate cancer, particularly given inconclusive research evidence to suggest otherwise for those not taking GAHT and call for clarity in PSA screening guidelines for this population to promote health equity.