Prostatic diseases in transgender women: A systematic review of diagnosis, risk, and management

Most transgender women have their prostate left in situ throughout and after their transition. Managing prostate‑related conditions in transgender women remains challenging due to the lack of clear recommendations. This review aims to summarize the available data on prostate health, including cancer screening and treatment, lower urinary tract symptoms, and prostate evaluation.

A comprehensive literature review was conducted in accordance with the PRISMA statement using PubMed, Embase, and The Cochrane Library, with the keywords (prostate), (lower urinary tract symptoms (LUTS)), (prostate evaluation), and (transgender women). All relevant data were analyzed.

Twenty studies were included in the final analysis: 15 focused on prostate cancer, four on LUTS, and one on prostate evaluation. A total of 961 prostate cancer cases were identified. Of the 17 detailed oncologic treatments, the most common were surgery and hormone therapy. Data regarding LUTS and prostate evaluation were very limited; the most frequently reported symptom was a split urinary stream. Surgical interventions for LUTS included two cases of transurethral resection of the prostate (TURP) and one Rezum procedure. Prostate evaluation was performed via transvaginal exam in 50 patients. Transvaginal ultrasonographic assessment of the prostate was feasible in 67 out of 70 patients (96%).

The present systematic review demonstrates that prostatic diseases can occur in transgender women. Neovaginal prostatic exam appears as the appropriate way to assess the prostate on physical exam. The paucity of data highlights the need to raise awareness of healthcare professionals and to promote further research on this critical issue.