What matters for the prevention of prostate cancer is the presence of a prostate and individual risk factors, not legal gender.
The prostate is a small gland located below the bladder. It is present in people who were born with one unless it has been surgically removed. This includes many transfeminine, non-binary and gender-diverse people, as the prostate is usually not removed during gender-affirming surgery.
Unlike breast, cervical and colorectal cancer, there is currently no organised population screening programme for prostate cancer. Decisions about PSA testing for prostate cancer surveillance should be made together with a healthcare provider, taking into account individual risk factors, age, life expectancy, and personal preferences.
More information is provided below.
What is the PSA test?
The prostate-specific antigen (PSA) test is a blood test that may help detect prostate cancer before symptoms develop.
Unlike breast, cervical and colorectal cancer, there is currently no organized screening program for prostate cancer. If you have a prostate, you can make an informed decision about whether a PSA test is right for you by discussing its potential benefits and limitations with your healthcare provider.
If you are at average risk of developing prostate cancer, you may consider having a first PSA test from the age of 50. This first test can provide a baseline PSA level, which may help determine whether future testing is appropriate and, if so, how often it should be repeated.
If you are at increased risk of developing prostate cancer, you may consider discussing PSA testing from the age of 45. Risk factors include:
- African or Caribbean ancestry;
- a family history of prostate cancer, particularly in a close relative;
- an inherited genetic variant associated with prostate cancer, such as BRCA2.
If you have one or more of these risk factors, discuss prostate cancer surveillance with your GP or specialist. Together, you can decide whether PSA testing is appropriate, when to start, and how often it should be repeated.
Are other tests available?
In addition to the PSA test, your healthcare provider may perform a digital examination of the prostate, particularly if you have symptoms or an abnormal PSA result.
This is usually performed as a digital rectal examination. After vaginoplasty, however, a digital vaginal examination may be more appropriate, as the prostate remains in front of the vaginal canal.
Gender-affirming genital surgery for AFAB anatomy
Gender-affirming surgery, including vaginoplasty and vulvoplasty, does not usually involve removing the prostate. It is generally left in place to reduce the risk of complications, such as urinary incontinence, urethral strictures and reduced sexual sensation.
If you are unsure whether your prostate was removed during surgery, ask your healthcare provider.
Estrogen therapy and prostate cancer surveillance
Current evidence suggests that gender-affirming estrogen therapy may reduce the risk of developing prostate cancer. However, the risk is the risk is not eliminated, and more research is needed to better understand how it affects prostate cancer risk, particularly among people with other risk factors. If you have a prostate, it is important to continue considering your prostate health, regardless of your stage of transition.
If you are using estrogens, let your healthcare provider know before your PSA testing.
Why? Estrogen therapy lowers PSA levels. As a result, PSA test results should always be interpreted in the context of ongoing hormone treatment. Some experts recommend using a lower PSA threshold (around 1.0 ng/mL) when assessing people receiving long-term estrogen therapy.
General Considerations
The information in this website is meant to provide general guidance and education. It cannot replace a medical consultation that takes into account a person’s medical history, risk factors, and preferences.
Whether surveillance or diagnostic testing is appropriate depends on a person's individual risk factors, symptoms and preferences. These tests also have limitations and possible downsides that should be discussed with a healthcare provider.
