Should I get tested for prostate cancer?
Screening for Prostate Cancer
At this time there are no prostate cancer screening guidelines specifically for trans women. However, in light of the fact that prostate cancer can occur in trans women, a conversation about screening should be approached thoughtfully and as an opportunity for the healthcare provider and patient to discuss, in necessary detail, the importance of testing and medical follow-up.
The decision to screen as well as the frequency of testing should also be impacted by the risk profile of a trans woman, including risk factors such as having a family history of prostate cancer or being of African or Caribbean decent. More information on the risk factors for prostate cancer can be found
here.
Prostate cancer testing may be considered not gender affirming for some transgender women, and screening may be both physically and emotionally painful for some patients. The decision to screen for prostate cancer, and how to do so, should be made by the patient in the context of a dedicated care-discussion with their healthcare provider.
The PSA Test
Prostate Cancer Canada recommends that all individuals with a prostate receive a baseline PSA test. The baseline PSA number can be used as part of a prostate cancer risk profile, along with age, family history and ethnicity to determine when subsequent testing is necessary. For more information about the PSA test visit our FAQ page
here.
If the decision to screen is made, the results of a
PSA test may be impacted by exposure to feminizing hormone therapy. Additionally, PSA levels will be decreased following orchiectomy and results >1.0ng mL-1 should indicate a need for further testing.
Physical Exam of the Prostate
For transgender women with a neo-vagina, the prostate is located anterior to, or in front of, the neo-vagina. Studies have shown that a neo-vaginal exam can allow for prostate examination in some women, depending on the length and rigidity of her neo-vagina. If a neo-vaginal exam is not possible, a digital rectal exam (DRE) would allow for prostate palpation if the patient is comfortable to do so. Transvaginal ultrasound for prostate volume may be more comfortable than a DRE. Prostate size is often smaller than expected in trans women and therefore, a DRE alone may be falsely reassuring to providers who are not familiar with the technique as applied with trans women.