Should I get tested for prostate cancer?

Testing 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 testing should be approached thoughtfully and as an opportunity for the healthcare provider and patient to discuss the importance of testing and medical follow-up.

The decision to test 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 black. 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 test 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 consider having a PSA test at age 50 or at age 45 if they are at high risk of developing prostate cancer. The decision to have a PSA test should be made after having a discussion with your health care provider about the advantages and disadvantages of testing and you should be comfortable with the decision. More information about the PSA test can be found here.

If the decision to test is made, the results 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.