The prostate is a gland in the male reproductive system that sits just under the bladder. The urethra passes through the prostate when it exits the bladder. It produces and releases a fluid that combines with sperm and seminal fluid (made in the testicles) to form semen.
As with any tissue or organ in the body, cells in the prostate can become cancerous. If you still have a prostate, you should be aware of the risk of developing cancer. This post aims to help improve your understanding of prostate cancer and how it relates to your transition.
Prostate cancer is reported as the most common cancer in UK males. However, there is very little research on prostate cancer in trans women. The available research suggests several things:
- Trans women have a prostate gland but it is often neglected
- It is easy to forget about something that has never caused you any trouble! Doctors can be nervous or anxious about talking to trans women about their prostate and sometimes trans women don’t know about their prostate. If you experience any new symptoms (see below) that you think might relate to your prostate, see your healthcare professional for advice.
- Trans women who have had lifelong lower T levels appear to have a lower risk of prostate cancer
- Research in trans women with prostate cancer does show that most cases have been diagnosed in those who began gender-affirming hormones in later life. Therefore, if you started hormones earlier in life, and thus had lower T levels for longer, you appear to be at lower risk of prostate cancer.
- Like most trans healthcare research, the evidence is scant and you should always see your healthcare provider if you are concerned about any aspect of your health.
- Evidence from a 2016 study showed no relationship between testosterone levels and prostate cancer risk.
- Gender-affirming hormones do not eliminate your risk of prostate cancer.
- Trans women who start HRT later in life should consider prostate screening in the same way that cis men should
- If you still have a prostate, you should always be aware of the risk of cancer and see your healthcare provider if you have any symptoms of prostate cancer or concerns about your health generally.
- Your risk of prostate cancer increases with age, regardless of your hormone profile.
What are the symptoms of prostate cancer?
Prostate cancer causes the prostate to grow bigger. Due to where it is situated in the body, this can put pressure on the bladder and urethra giving rise to symptoms which become apparent when passing urine. These include:
- Weak or unsteady urinary stream
- ‘Dribbling’ urine unintentionally
- Feeling like you can’t completely empty your bladder
- Straining when urinating
- Difficulty starting urination (hesitancy)
- Urinating frequently or more often than normal (especially at night)
- Needing to get to the toilet quickly (urgency)
These symptoms can be common for people with a prostate as they age. It is more commonly due to a benign (non-cancerous) growth of the prostate (benign prostatic hyperplasia) but you should always get new or changing symptoms checked by a doctor.
How is prostate cancer diagnosed?
Your doctor will examine your prostate and get a blood test from you. The examination is called a digital rectal examination and involves the doctor inserting a lubricated, gloved finger into the anus to feel the prostate. The blood test is a simple one and is usually taken from one of the veins in your arm. See our post about the Prostate Specific Antigen blood test here.
Sometimes, a biopsy is needed to confirm the diagnosis. This is done under local anaesthetic using a small needle and an ultrasound machine. Your doctor will be able to discuss the process with you in more detail as well as whether or not you might need a biopsy.
Treatment options for prostate cancer
These are variable and depend on your own personal circumstances. It is best to explore this with your own doctor as they know you better and will be able to advise you on all the options available so you can make an informed choice.