To characterize prostate-specific antigen (PSA) testing patterns, diagnosis, and treatment and management of prostate cancer in transgender and non-binary patients designated male at birth (TGNB DMAB) at a single tertiary care institution.

We retrospectively reviewed all patient encounters from March 2019 to February 2021 to identify TGNB DMAB eligible for PSA screening per American Urological Association guidelines. This cohort was analyzed to determine the rate of PSA testing, referral patterns, recommendations, and overall patterns of clinical care.

Among 216 TGNB DMAB patients identified, 86 (39.8%) had at least 1 PSA during eligible screening years. Median PSA at initial evaluation was 0.16 ng/mL (interquartile range <  0.04-1.14 ng/mL), with significant differences between patients on gender-affirming hormonal therapy or prior orchiectomy ( P   < .001). In the testing cohort, 45 (52.3%) patients continued PSA testing or further workup after initial evaluation, and 7 (8.1%) patients underwent prostate biopsy. Four (4.5%) were diagnosed with prostate cancer. On logistic regression, Black/African-American race was associated with decreased odds of undergoing any PSA testing (odds ratio 0.51, 95% confidence interval 0.25-1.01, P  = .054).

The PSA testing rate among TGNB DMAB patients is low compared to published rates among cisgender men. Race may also influence PSA testing patterns in this population; however, further studies are required to validate our result.