Hopkins urologic pathologists are laying the groundwork for understanding prostate cancer in a very small population: male-to-female transgender patients. Because the prostate is not typically removed, these patients still need screening, and they can still develop prostate cancer. 

“This was the largest to-date cohort of prostate cancer in transgender patients,” says pathologist Ezra Baraban, M.D., who was lead author of a study published in the American Journal of Surgical Pathology. In collaboration with scientists at Hopkins and institutions from across the country, Baraban and the study’s senior author, Jonathan Epstein, M.D., characterized the pathologic findings in a series of nine male-to-female transgender patients with an elevated PSA who underwent prostate biopsy; seven of them were diagnosed with prostate cancer. 

The team correlated the pathologic features of the patients’ tumors with their history of hormonal therapy and their clinical outcomes after the diagnosis of prostate cancer. The study’s findings may help guide evaluation and treatment of prostate cancer in this population. 

Some of the patients turned out to have metastatic prostate cancer – “indicating that although it is quite rare, aggressive prostate cancer can occur in transgender patients on long-term hormone therapy,” says Baraban. Another concerning issue relates to PSA. The hormone therapy that some patients take significantly lowers PSA – which means prostate cancer might be missed because the PSA is too low to raise any warning flags.