The Development of Prostate Adenocarcinoma in a Transgender Male to Female Patient: Could Estrogen Therapy Have Played a Role?

Prostate adenocarcinoma (PCa) is a rare diagnosis in the male to female transgender (MtFT) population with only a few case reports published in the current medical literature. Long standing beliefs of androgen suppression conferring a protective effect against prostate cancer development have been challenged by the literature citing adenocarcinoma development in the prostate of rodent models following combined estrogen and testosterone treatment.

We herein present a MtFT patient who presented with high grade PCa following 20 years of exogenous estrogen therapy.

Immunohistochemical (IHC) localization of estrogen receptor alpha (ER-α) and progesterone receptor (PR) demonstrated positive staining in stromal cells; while, androgen receptor (AR) demonstrated positive staining in malignant glands and weak scattered staining in adjacent stroma.

This pattern of staining raises concern for a possible contributing role of exogenous estrogen therapy in tumorigenesis. As awareness of gender dysphoria and acceptance of gender reassignment surgery has seen a recent increase, the unique needs of this population must be recognized. Prostate 77:824-828, 2017. © 2017 Wiley Periodicals, Inc.

The Prostate. 2017 Feb 13 [Epub]

Asma Sharif, Neha R Malhotra, Andres M Acosta, Andre A Kajdacsy-Balla, Maarten Bosland, Grace Guzman, Gail S Prins, Michael R Abern

Department of Pathology, University of Illinois at Chicago, Chicago, Illinois., Department of Urology, University of Illinois at Chicago, Chicago, Illinois.