Scientific Evidence of Prostate Cancer Progression Outcomes in Transgender Females after Hormone Replacement Therapy. A Scoping Review Protocol.

Transgender females undergoing hormone replacement therapy (HRT) as a component of the gender affirmation treatment (GAT) commonly retain their prostate, rendering them susceptible to developing prostate cancer (PC). Currently, patients with localized PC receive endocrine therapy (e.g., androgen ablation/castration). Once metastatic, patients undergo standard chemotherapy and/or novel treatment. Unfortunately, many fail to respond completely and develop untreatable, drug-resistant tumors consistent with reprogramming of crucial cell signal transduction pathways that promote tumor growth, invasiveness, and survival. There is no consensus among scientists or physicians on how HRT affects PC treatment options or its related signaling pathways, putting patients at risk for delayed diagnosis. This scoping review aims to analyze and collate the current scientific literature on PC progression in transgender females who have undergone HRT and how PC-initiated oncogenic pathways are impacted by HRT. The reviews findings can potentially inform transgender healthcare and research. This scoping review will follow the Population-Concept-Context methodology for Joanna Briggs Institution Scoping Reviews. Relevant peer-reviewed studies will be identified from the following electronic databases: MEDLINE (PubMed), Embase (Elsevier), CINAHL (EBSCO), and Scopus (Elsevier). Sources of unpublished studies/ grey literature to be searched include bioRxiv (Cold Spring Harbor Laboratory), medRxiv (Cold Spring Harbor Laboratory), and MedNar (Deep Web Technologies). The search strings using keywords such as gender-affirmation treatment, transgender females, and prostate cancer will be conducted using Boolean logic. There will be no limitation on language or date of publication.