Prostate cancer can be emotionally difficult for trans women and non-binary people.
From a physical point of view, there will be additional considerations for your medical team.
We hope that the following information is useful and please contact our team of friendly and supportive Orchid nurses who are here to help.
Whilst we at Orchid use the term ‘male cancer’ we recognise that this language might be dysphoric for the transgender and non-binary community affected by prostate cancer.
People who were registered male at birth and have not had their prostate removed may wish to consider prostate screening. This can include transgender women, and non-binary and gender-diverse people registered male at birth.
We know that Black cisgender men are at increased risk of prostate cancer with 1 in 4 being diagnosed, compared to the average rate of 1 in 8 seen in other cisgender men. This risk may also apply to Black trans women and non-binary people, but more research is needed to be sure.
People who have a family history of breast, ovarian or prostate cancer, or are known to have a mutation in the BRCA2 gene are at increased risk of prostate cancer and may wish to consider this when choosing whether to undergo prostate screening.
If you were registered female at birth, you do not have a prostate and do not need to consider prostate screening.
Taking oestrogen, testosterone blockers (antiandrogens), or having the testicles removed (orchidectomy) all reduce the levels of testosterone in the body and can reduce prostate cancer risk. Trans women receiving androgen deprivation therapy and oestrogens may have a 5-fold decrease in prostate cancer risk.
The reduction of testosterone in the body can also lower PSA (prostate specific androgen) levels, making the PSA test for prostate cancer less reliable. Most experts think you should have a PSA test before starting feminising hormones or testosterone blockers if you’re aged 50 or over, or over the age of 45 if you have a family history of prostate cancer, or if you are Black.
Screening is a test given to people with a higher chance of having a health problem so that information or early treatment can be offered. When there is a set schedule that invites people to these appointments, we call this a ‘screening programme.’
There is currently no national screening programme for prostate cancer in the UK. This is because it has not been proven that the benefits of testing outweigh the risks. Research is ongoing to see if there are certain groups of people who would benefit from prostate screening more than others.
Testing a person’s PSA level is an unreliable indicator for prostate cancer. Around 1 in 7 of those with prostate cancer have normal PSA levels. Occasionally, this test can give a false positive, showing cancer where there is none. This is why it is recommended to confirm a potential tumour with an MRI scan before undergoing biopsies.
The PSA test can find aggressive prostate cancer that needs treatment, but it can also find slow-growing cancer that may never cause symptoms or shorten life. Some people may face difficult decisions about treatment, although this is less likely now that most people are offered an MRI scan before further tests and treatment.
Instead of a national screening programme, there is an informed choice programme. This is known as ‘prostate cancer risk management’. It applies to healthy people aged 50 or over who ask their GP about PSA testing and aims to provide good information on the pros and cons of a PSA test.
If you are aged 50 or over and decide to have your PSA levels tested after talking to a GP, they can arrange for it to be carried out for free on the NHS. The PSA level is tested through a blood test. If results show you have a raised PSA level, the GP may suggest further tests.
You may wish to request a PSA test with your GP once you reach 50 even if you have no symptoms, so that you can establish a baseline value of your PSA level. This will help the GP interpret any potential changes in the future.
If you do choose to have a PSA test, a nurse or medical technician will use a needle to draw blood from a vein, most likely in your arm. The blood sample is then analysed in the lab to measure your PSA level. You should avoid prostate stimulation for at least a week before having a PSA test and should not have ejaculated during the previous 48 hours.
These recommendations usually refer to sex and masturbation, but might also include dilation. For this reason, we recommend that you consider your dilation schedule when booking your PSA test with the GP and try to arrange your appointment as far from your dilation as possible.
You may also be offered a digital rectal examination (DRE) to check the size and surface texture of your prostate. This is where the doctor puts a finger in your rectum to feel your prostate inside your body. The DRE is not a completely accurate test. Your doctor or nurse can’t feel the whole prostate and someone with prostate cancer might have a prostate that feels normal.
If you have had a vaginoplasty, this test might happen through your vaginal wall, instead of your rectum (back passage).
After the tests at your GP surgery, you may have further tests at a hospital. These can include an MRI scan and potentially a biopsy.
An MRI scan is done to see if there is any cancer inside your prostate. An MRI scan may not be possible if you have a pacemaker or other metal inside your body. You might have to wait a few weeks for a scan if you’ve recently had genital reconstructive surgery. You can read more about what to expect during an MRI scan on the NHS website: https://www.nhs.uk/conditions/mri-scan/
A biopsy will either be done as a transperineal biopsy or a transrectal ultrasound (TRUS) guided biopsy. If you’ve had genital reconstructive surgery that includes vaginoplasty then you may have a biopsy via the vagina or other routes. The urologist doing the biopsy will look at your scans before discussing the best approach with you.
We recognise that prostate cancer investigation begins with a conversation with your GP and that this might be difficult to navigate for some. Not all GPs are aware that transgender women still have their prostate after vaginoplasty. If your GP does not know you are trans, you may have to disclose this to access prostate screening. If you are unsure about how to navigate this conversation, it may be helpful to show them this webpage.
Other tips that might support you when attending your appointment include:
A prostate cancer diagnosis is hard for all patients but may experience additional emotional challenges. These may relate to being diagnosed with a cancer associated with your sex registered at birth, or it may be related to finding support that is inclusive of your gender identity.
Peer support can be a great help when someone is diagnosed with cancer. In the UK there are specific prostate peer support groups that are led by and for LGBT+ people. These include:
You can also call our freephone helpline on 0808 802 0010. Our friendly nurses are here to offer support and to answer your questions.
This page was written and created in partnership with Live Through This
The views and experiences of Trans women who attended a focus group helped inform the content.
