The campaign Blue November is aimed at raising awareness about the prostate cancer and highlights the importance of caring for men’s health. However, trans women and transvestites must also be aware of the risk of developing the tumor.
“Trans women and transvestites are at risk of prostate cancer for a specific reason: they have a prostate,” says Ubirajara Barroso Jr., urologist at the D’Or São Luiz network and head of the Department of Gender Affirmative Surgery at the Brazilian Society of Urology ( SBU), to CNN .
The specialist explains that this risk remains even among those who have undergone sexual reassignment surgery. “In surgery, we do not touch the prostate that is inside, close to the bladder. So, trans women are at risk of prostate cancer because, biologically, they were born with a prostate”, he explains.
According to Denis Jardim, national leader of the urological tumors specialty at Oncoclínicas, the prostate is usually kept in sexual reassignment surgery because its removal could increase the risk of urinary incontinence and other complications of the urinary system.
However, data on the incidence of prostate cancer in trans women and transvestites is still scarce, according to the expert.
“If we look at the recommendation guidelines, incidence data, how to diagnose, PSA values, the evolution of treatment, among others, there are few studies [que incluem a população transgênero]”, says Jardim to CNN .
“There have been some more recent studies on the topic. Perhaps one of the main ones was the published this year in Prostate of Cancer and Prostatic Disease. But, in fact, we need greater awareness and more data to make definitive statements about this scenario”, he adds.
Does hormonal transition reduce risk?
Although the data is still insufficient, experts say that the risk of prostate cancer in trans women is lower than in cisgender men especially among those who underwent hormonal treatment with testosterone inhibition.
“In the study published in Prostate of Cancer and Prostatic Disease, the risk was approximately two times lower in women transgenders between the ages of 50 and 64 compared to cisgender men. This reduction of risk may vary ofdepends, obviously, on age and also of when the process started of transhormonal formation”, says Jardim.
According to the expert, the testosterone is one of the main stimulators of prostate cancer . “So, as hormonal transition involves blocking testosterone and, often, supplementing estrogens, we see that this is one of the factors that causes prostate cancer to have a reduced incidence in transgender women”, he explains.
“However, some studies argue that if this tumor of prostate happen, still in lower incidence, it may have a slightly more serious behavior, precisely because it happened in an environment with the highest estrogen”, he adds.
Furthermore, according to Barroso Jr., the risk is lower when hormonal treatment with testosterone inhibition is carried out at a younger age. “We are increasingly seeing that trans women transition [hormonal] older, when there has already been enough hormonal action from testosterone for the risk to be equivalent [a homens cisgêneros]. It is possible that, in a few years, we will see an increase in the incidence of prostate cancer due to a later transition”, he states.
There is still no specific guideline for prostate cancer screening in trans women
Precisely because there are still no studies with sufficient evidence on the incidence and mortality from prostate cancer in trans and transvestite women, there are still no specific guidelines for this population regarding screening for the tumor.
“We must encourage screening to be similar to that for cis men, which is a visit to the urologist from the age of 50, for those who do not have a family history of cancer, and from the age of 45 for those who had a first-degree relative with prostate cancer”, advises Barroso Jr.
Prostate cancer screening is done through digital rectal examination and blood test to assess the PSA dosage (prostate-specific antigen). This is a protein produced by the prostate which, at high levels, may indicate a disease in the gland, including cancer.
In addition to the rectal exam and PSA blood measurement, tests such as prostate ultrasound and magnetic resonance imaging can also be included in the screening. Confirmation of the diagnosis is made through prostate biopsy via trans-rectal or trans-perineal route, guided by imaging tests.
Difficulty in accessing early diagnosis and adequate treatment is still a reality
Early diagnosis of prostate cancer is essential for successful treatment and a greater chance of cure. However, among the transgender population, access to this early-stage detection is still difficult.
“There are several factors related to the difficulty of accessing early diagnosis. Some of them are related to understanding itself. For many trans women who have surgery [de redesignação sexual]there is no understanding that the prostate is still there. Therefore, there is a need for awareness”, observes Jardim.
Furthermore, socioeconomic factors can also make access to adequate diagnosis and treatment for prostate cancer difficult. “In some situations there is greater marginalization, a socioeconomic difficulty for some transgender women, which we know can also be a barrier to access to health diagnosis and prevention”, adds the specialist.
Prejudice is also a factor in this difficulty. “Unfortunately, there is still a lot of prejudice towards transgender people, so there are numerous barriers. First, trans women are often afraid to go to public places because of offenses, because of violence. SUS service locations are crowded places, often places with very long, uncomfortable queues, which leads to long waits and a stressful environment”, considers Barroso Jr.
Another point, in Barroso’s opinion, is the lack of preparation of medical centers to serve the trans population. “Many do not use their social name and there are manyDoctors who, possibly, are not prepared and do not know how to deal, for example, with trans women or have a conscientious objection, do not want to provide care due to prejudice”, he adds.
Blue November should include trans women, experts argue
Experts say that the Blue November campaign should include the trans population and raise awareness about the risks of prostate cancer in trans women and transvestites.
“It is equally important to have greater preparation of the entire medical team, medical society, whether oncology, urology or family doctor, to have more training on how to deal with these women, whether through courses or conferences, so that, ultimately, these women women are better welcomed in the health system”, points out Jardim.
“Doctors in general, especially urologists and also gynecologists who deal with the trans population, in addition to the entire multidisciplinary team that deals with this population — whether psychologists, endocrinologists, plastic surgeons and social workers — must, in some way, guide and ask if patients have already seen a doctor to have their prostate evaluated”, adds Barroso Jr.
This content was originally published in Prostate cancer: trans women have a lower risk, but data is insufficient on the CNN Brasil website.
Source: CNN Brasil
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