For transgender women, gender-affirming surgery does not remove the prostate. This study finds prostate cancer is less common than in cisgender men—but still common enough that it cannot simply be ignored. After transgender women undergo genital gender-affirming surgery, the prostate remains in place, so an ongoing risk for prostate cancer remains.

But the rate of prostate cancer in this population is relatively unknown, and current screening guidelines are limited by this lack of data. Think of it like keeping one room in a house after renovating the rest: the room is still there, so it still needs its own safety check.

The risk among transgender women undergoing medical and surgical gender-affirming interventions remains unclear, although some studies report a lower risk than in cisgender men. This study compared prostate cancer rates among transgender women with rates in cisgender men.

The study began by examining whether prostate cancer risk was lower among transgender women than among cisgender men, an issue that remained unclear. Its findings nevertheless challenged the idea that prostate cancer among transgender women was rare enough to overlook, suggesting it may not be as uncommon as previously believed.

The study used deidentified electronic health records for more than forty thousand transgender women in the United States. The data compared prostate cancer rates among transgender women who had no medical or surgical intervention, those receiving estrogen hormone therapy without surgery, and those who had hormone therapy and gender-affirming surgery.

People with prostate cancer before the starting point were excluded, as were some people whose surgery may have had another reason. Among all trans women, forty-three prostate cancers were observed where one hundred nine would have been expected from US rates. The difference was especially clear among those receiving hormone therapy, supporting a substantially lower incidence overall.

The study observed forty-three cases of prostate cancer during an average follow-up of three years. Among transgender women receiving hormone therapy, the risk was lower than the comparison rate both for those aged fifty to sixty-four and across all ages.

The hormone-therapy group had received treatment for an average of two years before prostate cancer was diagnosed. Among transgender women aged fifty to sixty-four receiving hormone therapy, prostate cancer occurred about two times less often than in the comparison population.

Across all transgender women in the study, incidence was two point five six times lower. The lower rate may partly reflect the younger average age of the transgender women studied, but the difference remained after accounting for age and follow-up time.

Among those diagnosed with prostate cancer, the average prostate-specific antigen level was elevated, and elevated levels have been linked to more advanced and aggressive disease. This suggests that transgender women diagnosed with prostate cancer may have a higher disease burden and face challenges in treatment.

But increased levels are difficult to interpret until research establishes normal ranges for people receiving gender-affirming hormone therapy. The study concludes that prostate cancer occurred about two times less often among transgender women aged fifty to sixty-four receiving hormone therapy.

Even so, prostate cancer may not be as exceedingly rare among transgender women as previously believed. Rates remain lower than in cisgender men, but cases are not infrequent, so healthcare providers still need to consider prostate cancer when caring for transgender women.

Hormone therapy was linked with a lower rate of prostate cancer, yet cases still occurred and were not always easy to interpret. Screening and care still need to include the prostate, with guidance built for transgender women.