I sent Wheely's question to Prof. Richard Wassersug, an acknowledged expert on prostate cancer education. He's also included a reference to his book about life on ADT (which translates as "life without testosterone"). Here's his response:
Happy to see if I can answer Wheely's questions. But just to get to his core question... Wheely should get the PSA test. That is the simple, succinct answer.
However , if we take up each of his comments separately...
It is correct that his risk of prostate cancer is low on estrogen, but it still not inconsequential.. There is a ton of papers on this topic for the MtF population. I've listed below only about half of them from just the last year.
The PSA test does NOT produce "false positives" for prostate cancer since it is NOT a prostate cancer test. It is only a screening test. A rapid rise in PSA may suggest that a biopsy is appropriate. One needs a biopsy so a pathologist can look at the tissue and diagnose prostate cancer. The cancer can only be confirmed with biopsy. PSA alone is NOT a diagnostic test.
Once one has symptoms of prostate cancer the cancer is too often too advanced to be cured. So whether he has smptoms or not is not relevant.
Incurable prostate cancer typically invades the bones. That can be severely painful. And it can be fatal. In that situation, one doesn't simply die; too often it is a protracted and painful death..
I could go on. But in my view, Wheely should get the PSA test!
Note: I am NOT an MD. I happen to be a prostate cancer patient who has been on high dose estradiol for over twenty years to control prostate cancer.
Richard Wassersug, PhD
Honorary Professor
Faculty of Medicine
University of British Columbia
www.LifeOnAdt.com (
http://www.LifeOnAdt.com)
Note: The third edition of the book Androgen Deprivation Therapy: An essential guide for prostate cancer patients and their loved ones is now out. See:
https://www.springerpub.com/androgen-de ... 84023.html (
https://www.springerpub.com/androgen-de ... 84023.html). The book was First Place Winner of American Journal of Nursing 2024 Book Award in Consumer Health.
Refs:
Tyagi S, Tyagi S. Incidence of Prostate Cancer in Transgender Women Undergoing Androgen Deprivation Therapy: A Review. Indian J Endocrinol Metab. 2023 Nov-Dec;27(6):476-479. doi: 10.4103/ijem.ijem_53_23. Epub 2024 Jan 11. PMID: 38371191; PMCID: PMC10871014.
Crowley, F., Mihalopoulos, M., Gaglani, S., Tewari, A. K., Tsao, C. K., Djordjevic, M., ... & Lundon, D. J. (2023). Prostate cancer in transgender women: considerations for screening, diagnosis and management. British Journal of Cancer, 128(2), 177-189.
Manfredi, C., Ditonno, F., Franco, A., Bologna, E., Licari, L. C., Arcaniolo, D., ... & Autorino, R. (2023). Prostate cancer in transgender women: epidemiology, clinical characteristics, and management challenges. Current Oncology Reports, 25(12), 1431-1443.
Kaplan-Marans, E., Zhang, T. R., Zhao, L. C., & Hu, J. C. (2023). Transgender women with prostate cancer are under-represented in national cancer registries. Nature Reviews Urology, 20(4), 195-196.
) he thinks the risk is low, but wants to know if I want to still get PSA tests... (I looked in the SOC v8, which has no definite advice - best quote: "there is no evidence to guide how often to screen for hormone-related cancers with prostate exams, PSA measurements, mammograms, etc. ")