GenderSong logo       Prostate Cancer and the M-to-F Transsexual

To help explain how prostate cancer affects a MtF transgender -- and to further my own understanding -- I sought out an illustration of how all the pieces come together inside me.  After searching unsuccessfully on the internet, I found a model of the male bladder, prostate, urethra, and genitals in my doctor's office.  I photographed it, cleaned up the image, and labelled it.

Normal male bladder and prostate
Figure 1.  Normal Urinary Bladder and Prostate

This is the relationship of parts in a normal, non-cancerous male.  Unless you've had some surgery or disease in this area, it's probably a good depiction of what you look like inside.

Normal Vaginoplasty

Now let's suppose you are transsexual. You get on hormones, work with a therapist, survive your year of real life experience, and go through vaginoplasty. You will have a neo-vagina positioned approximately like this.

Location of Neo-Vagina in Normal MtF Transgender
Figure 2.  Approximate Location of Neo-Vagina in Normal Male

The prostate and the other glands leading into and through it are still present, though most everything will have been reoriented. Repositioning of the urethra is not well-illustrated in this figure. Also note that several different surgical techniques are employed today, so the details of the vaginal construction will vary from surgeon to surgeon, and from patient to patient. This author believes that the illustration nonetheless captures the essential details of the relationship of the neo-vagina to existing functional parts.

One of the important relationships involves the prostate. During coitus the male partner's member will press on the prostate, stimulating it and intensifying pleasurable sensations.

Radical Prostatectomy

Here is another scenario.  Let us suppose that you, like me, have developed prostate cancer.  There are many treatment options available.  Selection of the method for you is a choice you and your cancer surgeon make, and it is based on the state of the cancer's progress, your age, your health, and other factors.  I was relatively young (53), and I agreed with my surgeon that surgical removal would be the best choice for me.

There are several surgical techniques in use today to completely remove the cancerous prostate.   However, most surgical removals also include removing the seminal vesicle as well as the prostate, and relocating the bladder, as shown in Figure 3.  These surgical procedures leave scar tissue behind, as shown by the purple band in the illustration below.

Relocated Bladder and Scar Tissue after Prostatectomy
Figure 3.  Relocated Bladder and Scar Tissue after Prostatectomy

Non-surgical procedures, such as external beam radiation, can also be used to kill prostatic tissues without removing them. This author has no information about the state of the bladder and other tissue surrounding the prostate after non-surgical treatments. It can be assumed that death of the tissue by radiation will result in some degree of scarring around the prostate.  Whether it is more or less than surgical treatment, I cannot say.

Impact of Prostatectomy on Vaginoplasty

Scar tissue around the relocated bladder constrains the space that your gender surgeon would otherwise use for your neo-vagina. See Figure 4.

Neo-vagina after Prostatectomy
Figure 4.  Neo-Vagina after Prostatectomy

The truncation of the neo-vagina is not a function of the surgeon's skill; there is simply scar tissue where the vagina would penetrate deeper into the body.   It is undesirable for the vaginoplasty to be built upon old scar tissue; there are too many unknowns for the surgeon.  The missing prostate is also not attributable to the GRS surgeon, but it is likely to reduce the motivation for male penetration because there is no prostate to receive stimulation as would normally occur during intercourse with the neo-vagina shown in Figure 2.  Furthermore, you may have great difficulty even finding a male with a member short enough to find the truncated vagina satisfying.

Implications for You

If you are transgendered to any degree, then there may be some remote chance that you might be, or become, a transsexual; I know that could happen because it happened to me.  If you, too, are diagnosed with prostate cancer, first of all you must open the topic with your cancer urologist, for these reasons:

  1. You need to grow enough to face who you really are, and to discuss it.
  2. There may be other surgical alternatives that would make SRS less challenging in the future. Unless your urological oncologist knows that these issues need to be considered, there is no need to do so.
  3. Knowing that you are transgendered may help you and your urologist tip the balance toward radiation instead of surgery. Or, SRS might be a way of treating your prostate cancer -- and a way that being medically necessary might be covered by your health insurance. After all, before the 1980's, castration was the best way to treat prostate cancer.

I don't know what happens to the prostate after the tissue has been killed with radiation. Yes, the prostate cells and the cancer cells die, but what happens then? After the dead tissue has been reabsorbed into the body, does your bladder gradually swell to fill the space? If so, that might be a better choice if you need SRS in the future. On the other hand, scar tissue from the radiation may be as bad or worse than scar tissue from surger.

You must talk about these issues with your doctor if you are diagnosed with prostate cancer. Please come out of denial enough to protect your future: discuss your situation with your urologist.

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