Biological women who have never undergone gender-affirming surgery do not have a prostate gland. They do, however, have a pair of small structures called the Skene’s glands, located near the urethra. These glands produce prostate-specific antigen (PSA), the same protein measured in men to detect prostate cancer. Because of their similarities to the male prostate, Skene’s glands are sometimes referred to as the “female prostate.” These glands can develop cancer, although such cases are extremely rare.

Transgender women, meaning individuals assigned male at birth who have transitioned, retain their prostate gland unless it is surgically removed. This means they remain at risk for prostate cancer, even if they have undergone hormone therapy or gender-affirming genital surgery.

Female Prostate (Skene’s Gland) Cancer

Cancer of the Skene’s glands in cisgender women is extremely uncommon but has been documented in medical literature. These malignancies can behave similarly to prostate cancer in men, showing PSA production and local tissue invasion.

Evidence confirms that PSA, while commonly thought of as a male biomarker, is also present in women in small amounts. Elevated PSA levels in women can signal Skene’s gland disease, including cancer, although benign causes such as inflammation or infection are more common. Laboratory-based research has shown that the measurement of PSA in women’s serum is possible with highly sensitive detection methods, confirming that the gland has a measurable physiological output.

Because female prostate cancer is so rare, there are no standard screening recommendations for the general population. Most diagnoses occur after urinary or pelvic symptoms prompt imaging or biopsy. While the rarity means that the overall risk to cisgender women is very low, awareness among physicians is important for timely diagnosis in suspected cases.

Prostate Cancer in Transgender Women

For transgender women, the situation is significantly different. Even after orchiectomy and long-term estrogen therapy, the prostate gland typically remains in place. This means the risk of prostate cancer is still present, although hormonal changes may influence disease characteristics.

A recent clinical study of transgender women over the age of 45 found that average PSA levels in this group were 0.21 ng/mL, far below the typical male reference range. Despite the low PSA values, imaging using MRI still detected suspicious lesions in a small percentage of patients, with one case showing a high suspicion score. Biopsies in that study were negative, but researchers emphasized that the true long-term risk is unknown due to the limited number of cases followed. This underscores the importance of tailored screening strategies for transgender women, particularly as they age.

Risk Factors and Awareness

For transgender women, most known prostate cancer risk factors from the male population still apply, including older age and family history. The influence of long-term estrogen therapy on prostate cancer incidence remains unclear due to the lack of large-scale, statistically significant studies in this population.

In cisgender women, Skene’s gland cancer is too rare to identify clear environmental or genetic risk factors. However, research on general prostate cancer awareness shows that many women, regardless of background, have limited knowledge of prostate cancer symptoms and screening. One large-scale systematic review found that while women often had moderate knowledge of signs and causes, their understanding of screening methods was poor. This knowledge gap matters because women often play a significant role in encouraging their partners or family members to seek early medical attention for prostate issues.

Diagnosis and Treatment Approaches

In transgender women, diagnosis follows the same pathway as in cisgender men. This includes PSA testing, prostate MRI, and biopsy when needed. For Skene’s gland cancer in cisgender women, diagnosis is generally symptom-driven, using imaging and tissue biopsy after urinary or pelvic complaints.

Treatment for both transgender women and cisgender women with Skene’s gland cancer is modeled on existing prostate cancer protocols. This can include surgery, radiation therapy, and, when appropriate, hormone-based treatments. Because Skene’s gland cancer is so rare, individual treatment plans are often adapted from male prostate cancer literature, with modifications for anatomical differences.

Why This Matters More Than You Might Think

While prostate cancer is most common in men, it is not an exclusively male disease. Transgender women are at measurable risk because they retain the prostate, and cisgender women can develop cancer in the analogous Skene’s glands, though this is rare. For both groups, lack of awareness can lead to delays in diagnosis, which in turn may affect treatment outcomes.

The key message is that prostate cancer risk depends on anatomy rather than gender identity alone. Health professionals should recognize these risks, and patients should feel empowered to discuss concerns about urinary or pelvic symptoms regardless of gender. This awareness can lead to earlier detection, better treatment options, and ultimately improved outcomes.