title: The Development of Prostate Adenocarcinoma in a Transgender Male to Female Patient: Could Estrogen Therapy Have Played a Role?
abstract: BACKGROUND
  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.
  
  
  METHODS
  We herein present a MtFT patient who presented with high grade PCa following 20 years of exogenous estrogen therapy.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Asma
authors.initials: A
authors.lastname: Sharif
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Neha R
authors.initials: NR
authors.lastname: Malhotra
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Andres M
authors.initials: AM
authors.lastname: Acosta
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Andre A
authors.initials: AA
authors.lastname: Kajdacsy-Balla
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Maarten
authors.initials: M
authors.lastname: Bosland
authors.affiliation: Department of Pathology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Grace
authors.initials: G
authors.lastname: Guzman
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Gail S
authors.initials: GS
authors.lastname: Prins
authors.affiliation: Department of Urology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Abern
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000601:surgery; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000379:methods; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000379:methods; D057829:Gender-Affirming Procedures / Q000379:methods*; D013739:Testosterone / Q000378:metabolism; D063106:Transgender Persons; D016896:Treatment Outcome
chemical_list: D004967:Estrogens; D013739:Testosterone; D017430:Prostate-Specific Antigen
keywords: estrogen; male to female; prostate adenocarcinoma; testosterone; transgender