At every stage of the cancer continuum, the management of sexual and gender minorities with prostate cancer requires a thoughtful and multidisciplinary approach. For example, it is important to recognize that receptive anal intercourse, common among sexual minority men-i. e. gay and bisexual men-can potentially elevate prostate-specific antigen (PSA) leading to overdiagnosis and overtreatment. Additionally, it is important to understand that sexual minority men with prostate cancer might engage in insertive and/or receptive anal intercourse, as opposed to insertive vaginal intercourse, requiring a treatment conversation that expands beyond the usual discussion of sexual health in prostate cancer patients. For gender minorities-i.e. transgender women or trans feminine individuals (those recorded male at birth with feminine gender identities)-it is important to consider gender affirming hormones and pelvic surgeries as they can cause diagnostic and treatment challenges, including PSA suppression, more aggressive disease, and anatomical changes. Furthermore, it is essential to recognize that gender minorities are a diverse cohort and may or may not be on gender affirming hormone therapy and may or may not have received or intend to receive pelvic affirming surgery. In this seminar article, we highlight considerations for personalized management of prostate cancer in sexual and gender minorities to improve care for this understudied cohort and enhance health equity.
Urologic oncology. 2024 Jul 09 [Epub ahead of print]
Daniel R Dickstein, Channa Amarasekera, Ronald C Chen, Paul L Nguyen, Karen E Hoffman
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY. Electronic address: ., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL., Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, KS., Department of Radiation Oncology, Dana-Farber Brigham Cancer Center, Boston, MA., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.