Case – Laparoscopic radical prostatectomy in a transgender woman after gender-affirming vaginoplasty
Bibliographic record
Abstract
TGD individuals on GAHT. 4,10This may contribute to negative experiences with screening and accessing of health services. 11o date in the literature, the 12 publications that summarize the care of transfeminine patients with prostate cancer do not include a case where prostatectomy was performed after penile-inversion vaginoplasty (PIV; Table 1).Herein, we present a case of a transgender woman who underwent laparoscopic radical prostatectomy after PIV, with the goal to preserve neovaginal length and function.We described the work-up and management of this patient with an interdisciplinary team of experts in Urology, Radiation Oncology, Plastic Surgery, and Endocrinology. CASE REPORTA 66-year-old transgender woman was referred to urology by her primary care provider for an elevated, first PSA at 26.8 µg/L and bothersome lower urinary tract symptoms including nocturia, incomplete emptying, hesitancy, dysuria, and recurrent urinary tract infections.She had been on feminizing gender-affirming hormone therapy since the age of 54 and underwent bilateral orchiectomy and PIV at 57-years-old.Her medications included oral estradiol therapy 4 mg daily with serum estradiol levels in the normal premenopausal female range, oral medroxyprogesterone acetate 10 mg daily, and oral finasteride 1.25 mg daily.Her family history was notable for her father who was diagnosed with prostate cancer in his 80s.Her other past medical history included hepatitis C, which was treated 11 years prior with interferon/ribavirin and cleared.She was a past smoker 30 years ago.Her total testosterone level on presentation was 0.4 nmol/L, free testosterone 5 pmol/L, bioavailable testosterone 0.1 nmol/L, progesterone 0.8 nmol/L, and sex-hormone binding globulin 57.4 nmol/L.Repeat PSA levels were 26.3 µg/L, 27.9 µg/L, and 23.9 µg/L.In the clinic, a transvaginal prostate exam was normal, with no palpable nodularity, asymmetry, or tenderness.Cystoscopy demonstrated a non-obstructing prostate, recessed urethral meatus, and a normal bladder.Despite her small prostate, uroflowmetry revealed a peak flow of 9 mL/s with a PVR of 163 mL. WorkupAn ultrasound-guided transvaginal prostate biopsy was performed and reported a 16 mL gland with Gleason 9 (4+5) prostate adenocarcinoma.Nine of 12 cores were involved, with malignant core lengths ranging from 3 to 14 mm.There was no evidence of extracapsular or perineural invasion (cT1N0M0).The staging CT abdomen/pelvis and nuclear medicine bone scan were both negative.Pelvic MRI demonstrated the anterior neovaginal wall laid directly on the posterior surface of the prostate with no intervening fat plane, and no adenopathy or signs of extra-prostatic involvement.The case was discussed at a Joint Genitourinary Oncology conference with Urology, Pathology, Radiology, Medical and Radiation Oncology, where the consensus was that only suitable options for definitive therapy were either surgery or external beam radiotherapy (XRT).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.005 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".