Regular prostate cancer screening is crucial for anyone with a prostate, beginning at age 45—or age 40 for Black individuals or those with a family history of the disease, according to the American Cancer Society. Having a parent or sibling with prostate cancer more than doubles a person’s risk.
Screening is typically performed with a prostate-specific antigen (PSA) blood test, which measures a protein produced by the prostate gland. Yet studies suggest that gay men and transgender women are screened less frequently, even when they meet guidelines for regular testing. That gap, experts warn, can delay detection and treatment.
“Prostate cancer screening saves lives,” said Dr. Kirtishri Mishra, a board-certified urologist and Director of Sexual Health and Gender Reconstructive Surgery at MetroHealth. “The disease is very treatable when caught early, but if it spreads, it can be deadly.”
Barriers to Care
Dr. Mishra points to systemic issues that make consistent screening less accessible for LGBTQ+ patients, including healthcare discrimination and a lack of provider awareness. Black gay men and Black transgender women often face compounded disparities.
“Providers aren’t always comfortable discussing these issues with LGBTQ+ patients,” he said, emphasizing that clinicians must take responsibility for building inclusive care.
Mishra, who has specialized in gender-affirming surgery, said he has had to examine his own practices after realizing how bias can affect patient communication—such as failing to include partners in treatment conversations. His message to colleagues: “Sexuality and gender should be fully integrated into cancer care.”
Treatment and Sexual Health
Prostate cancer treatments—surgery and radiation—carry side effects such as incontinence, erectile dysfunction, and, in some cases, rectal irritation. While these effects are common to all patients, their cultural impact can be different.
For gay men, sexual health is often closely tied to identity and intimacy, Mishra explained. Erectile dysfunction can create emotional strain in relationships if it prevents one partner from participating in sexual activity.
“The conversation must go beyond medical facts,” Mishra said. “We talk about intimacy, how treatment affects sexual practices, and strategies for maintaining connection.”
MetroHealth has launched a rehabilitation program to address these needs. Patients meet with sexual health specialists before treatment, sometimes beginning medication to support blood flow and healing. Pelvic floor therapy is also used to help manage incontinence.
Transgender Women Remain at Risk
Mishra emphasized that transgender women remain at risk for prostate cancer, even after gender-affirming surgery. During vaginoplasty, the prostate is typically left in place to preserve sexual function and avoid incontinence. While hormone therapy may shrink the gland, it does not eliminate risk.
“Research I contributed to in 2024 shows prostate cancer is not rare among transgender women, despite previous assumptions,” Mishra noted. “There’s still much to learn, but the message is clear: trans women need screening.”
He urged patients to seek culturally competent providers and pointed to the MetroHealth Pride Network as a model of inclusive care.
The MetroHealth Pride Network
The Pride Network delivers primary, mental, and gender-affirming care with staff trained in LGBTQ+ health needs. Providers are available at multiple MetroHealth locations, including Brecksville, Brooklyn, Cleveland Heights, Parma, and Rocky River, as well as at the LGBT Community Center of Greater Cleveland.
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