Prostate Exam For Post-Op MtF Women?

[Shantel]

I found four links to this subject here at Susan's, and although many post-op women don't care to think of such things again I decided to bring the subject back up as it may be very important to someones survival in the future. It's important to know that the prostate doesn't get removed during SRS, because it's wrapped around the urethra just ahead of the bladder. It can be removed surgically but the patient will be wearing Attends for the rest of her life. So, the point I'm heading to here is that this little piece of equipment is necessary especially if you expect to enjoy a pleasurable little discharge during orgasm in the future. The reason it should be checked is that although it shrinks following several years on female HRT the probability of ever having a problem is extremely limited, however prostate cancer has become epidemic in older people and is driven by two factors: (1) With age comes less sexual activity and the fluids remain there almost stagnating over time. (2) It has been discovered that prostates collect concentrations of heavy metals (environmental contaminants) over time, these could come from the chemicals in soaps, cologne, perfume, deodorants, etc. These are potential triggers for prostate cancer. The prostate normally works like one of those little rubber squirt guns we had as kids, during that wonderful muscle contraction we all know as an orgasm, the juices become that pleasurable little squirt at climax for the post-op MtF woman.

[Catherine Sarah]

Thank you Shantel,
For your very informative post. I'm having a little issue with mine just at the minute, and was considering having a chat to my GP about, "If in doubt, rip it out."

I'll know by the end of March how the repair process is going.

Be safe, well and happy

Lotsa huggs
Catherine

[AbraCadabra]

Here is the deal,

A blood test will show if your prostate shows signs of cancer - long before any doctor by finger exams would be able to feel it. Cancer grows from the inside out.
If the you can feel prostate cancer it is mostly far too late to only medicate it with e.g. Androcur.

The other item is BPH (Benign prostates hyperplasia) a non-cancerous puffy swollen prostate which will show up by not being able to empty your bladder properly (after some years of BPH) and not having a good strong 'stream' and dribbling (also only after some years).
I had all that before staring on HRT.
It started in the my mid 40s and slowly got worse by late 50s to early 60s!

My doctor is telling me, the old finger-up-your-anus 'inspection' is not much good. Either you know already you have BPH, and he will feel it +/-, or you will show up in a blood test for signs of cancer and he hopefully will NOT YET feel it, lest it be pretty far advanced.

Post-op I now pee like Niagara-Falls and my bladder empties all the way, though I have not done any more blood tests for cancer.

Now should I? Maybe.
Not too sure what for, because I had no signs of cancer before when I had BPH, and now all sign of BPH have disappeared post-SRS, in fact 1 year before SRS when on HRT for about ½ a year.

Lastly if MtF post-op it be a bit odd if Mrs. so and so, is having blood tests for liver, kidneys, hormones and then for PROSTATE cancer...
That means you would need to do some explaining, there is no cancer test for Skene's glands the equivalent female item, not that I have very heard of.

Just my 2 cents,
Axélle

[Cindy]

Once you are on AA and on HRT the risk of prostate cancer are dramatically reduced.  The blood test for Prostate Specific Antigen (PSA) is quite inaccurate, unfortunately. So the FUB (finger up bum) is still practised widely. By experienced Doctors it can be quite reliable and if there are signs then a biopsy is called for.

But it is definitely worthwhile being checked if you are 50+ as part of your routine physical.

It is sad that many cis males do not get checked for what is, in the early stages, a very treatable cancer, but leave it until they are in physical distress and then it is not very treatable. All because of fear. And the fear of a FUB will be treated (often) by chemical or physical castration. For cis males not a good outcome I would have thought.

Cindy

[AbraCadabra]

Cindy,
interesting you say that PSA test in not very reliable i.e. quite inaccurate.
I wonder why my doc is of the opposite opinion...

I guess he dislikes FUB (with tgs?) more then I do.
In fact by now - I could not care less. 3x / day dilating somehow 'hardens' one to that fact.

Yet he tells me - and actually showed me on pictures - how it is rather impossible to detect early prostate cancer by FUB.

Now should I insist on FUB? In fact I did at one stage, and he obliged, but told me that it's just not that easy, not even to assess the stage of BPH... and my bladder was already dented in! So Ct scan it would be then – I guess.

That would mean finding some new medic that be expert at FUB... not sure I'd enjoy the search - not really...

Axélle

[Joelene9]

    Yes, you must have the PSA done once a year.  I had gone through a 4 year cancer scare because of the PSA numbers were over 4.0 ng/ml.  This was the trigger for me to go on HRT.  I tried herbal HRT and prostate remedies a year before, but they did nothing to bring down the PSA numbers.  The HRT has brought it down to 0.6 ng/ml from a high of 5.8.  My doctor thinks it was prostatitis due to the quickness of the PSA drop.  I will still have to take a PSA exam yearly.  Prostate cancer runs in my family. 
  There is a new blood test called the PCa that detects the cancer DNA and can tell how far into it is.  It is undergoing trials by the FDA.  There are two types of cancers of the prostate, castrate (T blockers and hormones, sometimes with an orchie, with the hormones usually on older men, the orchie as last resort) and non-castrate (surgery, radiation, and a new DNA specific t-cell treatment).  Usually both types are present.  Of men diagnosed with prostate cancer, 85% die from something else if they do no treatments,  87-88% will die from something else if treated, a small difference.  This is why to treat or not to treat question is so controversial. 
  A lot of men treated did not like the side effects of the treatment, calling it worse than the disease.  The side effects are, incontinence of the bladder and or the anus, impotence, bleeding, and pain.  The surgery causes most of these symptoms with the biopsy causing the other percentage.  The test procedures today are the PSA followed by the biopsy.  The biopsy is performed via the anus, using a gun type device with a dozen needles to collect samples from different regions of the prostate.  The newer test procedures would be if the new test is approved is: +PSA> +PCa> +biopsy = treatments.  Since the PSA test has a 15 - 17% false negative as well as the 85% false positive, the doctor may order the PCa test anyway. 
  If you're younger than 60 and are diagnosed with it, odds are that you will die of it more than those past 60.  Dan Fogelberg, the singer who sang about his father in "The Leader of the Band" died of the faster progressive version of prostate cancer at the age of 56.  His father died early as well from the same thing.
  If you are on female HRT, the doctor may trigger further testing at 2.0-2.5 ng/ml instead of the 3.0 - 4.0 ng/ml on the PSA.  If you started HRT before 50, odds are you'll never worry about it.  If your father or one of your grandfathers or blood uncles have it, yearly testing is a must.   
  Joelene

[Shantel]

That would mean finding some new medic that be expert at FUB... not sure I'd enjoy the search - not really...
Axélle

The FUB routine has always been a bummer for me too because that's always been a one way operation back there. I had dealt with a nice young nurse practitioner at the local VA hospital that had me pegged as a real anomaly following my first visit. She had me come back several times and insisted on giving me a breast exam twice and the finger wave. She even went so far as to call another woman in to look at me sitting there in only my light blue underpants. The other woman said, "Oh my!" and the nurse practitioner introduced her as a dermatologist whom she wanted to look at a dark spot on my back. Finally after getting dressed I put my arm around her shoulders and told her, "Honey, I think you're developing a nasty fetish here, I think we're done!" We both laughed about it, and on occasion when I see her at VA she waves and smiles. It's an odd way to make friends, but I had to tell you all because even in negative circumstances we are way ahead by letting it become a humorous event rather than get bent out of shape over it. I always like to say, "Was it good for you doc? Because I'm not really into that sort of thing!"

[leflauren678]

Some VERY Dangerous Mis-Information:

however prostate cancer has become epidemic in older people and is driven by two factors: (1) With age comes less sexual activity and the fluids remain there almost stagnating over time.

There is NO evidence that prostate cancer is associated with decreased sexual activity or stagnation of prostatic secretions (nor is there evidence that decreased sexual activity causes stagnation of prostatic secretions). Prostate cancer is associated with aging (as with most cancers) due to a breakdown of our body's defenses against cancer (immune system) and increased mutations (due to normal oxidative stresses from metabolism, UV exposure, chemical exposures)

(2) It has been discovered that prostates collect concentrations of heavy metals (environmental contaminants) over time, these could come from the chemicals in soaps, cologne, perfume, deodorants, etc. These are potential triggers for prostate cancer.

There is SOME evidence that heavy metal contamination MAY increase the risk for prostate cancer (however the evidence is much stronger for other cancers, leukemia & lymphoma). These are from exposures to industrial heavy metals and pesticides. There are NO heavy metals in soaps, cologne, perfume, or deodorants.

A blood test will show if your prostate shows signs of cancer - long before any doctor by finger exams would be able to feel it. Cancer grows from the inside out.
If the you can feel prostate cancer it is mostly far too late to only medicate it with e.g. Androcur.

Wrong Again! A digital rectal exam is much better at detecting prostate cancer than a PSA blood test. Nearly all prostate cancer grows from the OUTSIDE back wall of the prostate making it very easy to detect on a digital rectal exam. (Benign Prostatic Hyperplasia (BPH) grows from the inside out, which is why it causes difficulty urinating.) Both the US Preventative Services Task Force (USPSTF) and the American Cancer Society recommend AGAINST the use of the PSA blood test for screening because it detects both prostate cancer and BPH. PSA is useful in tracking people who have had a previous diagnosis of prostate cancer to see if it has spread or recurred, but not for routine screening.

-Lef

[Shantel]

Good to know of your learned expertise concerning this issue, I'm simply going on the information that the doctor gave me and thought I'd pass it on fro the good of others here. Thanks!

[AbraCadabra]

Some VERY Dangerous Mis-Information:

[clipped]
Wrong Again! A digital rectal exam is much better at detecting prostate cancer than a PSA blood test. Nearly all prostate cancer grows from the OUTSIDE back wall of the prostate making it very easy to detect on a digital rectal exam. (Benign Prostatic Hyperplasia (BPH) grows from the inside out, which is why it causes difficulty urinating.) Both the US Preventative Services Task Force (USPSTF) and the American Cancer Society recommend AGAINST the use of the PSA blood test for screening because it detects both prostate cancer and BPH. PSA is useful in tracking people who have had a previous diagnosis of prostate cancer to see if it has spread or recurred, but not for routine screening.

-Lef

Now would that be the first time that medics do not agree?

This is 180 deg. opposed to what I been told - and all I have is my own body to verify some that is being said.
I had pretty serious BPH and NOTHING what ever showed up on the PSA test.
Nothing, all 100% normal.

So much for "it detects both prostate cancer and BPH" ... not with me.

And as for cancer growing from inside to outside, yet another 180 deg opposed medical opinion I'm told to what is now said.

So who has it right.
I'm in no WAY predestined to pursue this argument and can only speak from personal BPH experience. That will just have to do for now.

Axélle

[Joelene9]

  PSA has a High false negative rate.  That's why a lot of men with BPH will not show much of anything on the PSA test.  My case of prostatitis it did.  It went up and hovered around 5.2 ng/ml for the four years.  My urination problems was from the constant erections I had.  My doctor surmised that the high T levels were decreasing with pulses of high T that irritated the prostate and brought on the much higher libido.  Prostatitis has been known to trigger the onset of the progressive cancers.  Prostatitis is caused by the pulsing of the T in later years with bacterial or viral infections that can occur in the younger set.  Cancer can start anywhere in the prostate, that's why the dozen darts during the biopsy. 
  Funny, when I ordered the herbal saw palmetto, on the same webpage there were advertisements for other BPH aids, including "100 male catheters for $xx.99!".  OWW!
  Joelene

[titsup]

As a post op you probily had a blood test called a PSA Prostrate Specific Antigen. It is important that you retain the result of this test post op as it act a basis of comparision after you become post op.

Personely, it is poor form for a post op to be subjected to a digital exam, as the blood work up is much more telling.

hope that helps

[Steffi]

Is the FUB appropriate anyway since post surgery the prostate will be above the neovagina in approximately the G-spot position?
Surely finger in vagina would be the way?

[Cindy]

There is a recent review. Prostate Cancer Screening K.Sikaris Pathology Feb 2012 44(2) p 99-109.

Just quoting a part to do with DRE "DRE can also detect subclinical rectal tumours and is a relatively simple procedure for clinician and patient. DRE was first promoted as a screening test in 1905 and for the next 75 yrs this was the only hope for a cure. More recently, advice remains to always include DRE in prostate screening because DRE can detect PC when everything appears normal.. Recent studies continue to show DRE improves the detection of of PC, regardless of new advances in blood testing including free to total PSA ratio and PSA velocity"
"The main problem with DRE is that by the time a prostatic cancer is palpable, it has usually spread .... at least 2/3 of the PC detected by DRE have already spread and are incurable"


So I think it means we should get as many screens as we can!!

[titsup]

Is the FUB appropriate anyway since post surgery the prostate will be above the neovagina in approximately the G-spot position?
Surely finger in vagina would be the way?

I think Steffi has the best ideal....lol

Thank you Steffi

[leflauren678]

Is the FUB appropriate anyway since post surgery the prostate will be above the neovagina in approximately the G-spot position?
Surely finger in vagina would be the way?

The appropriate term is DRE (digital rectal exam), not FUB.

DRE is the most effective method because the vast majority of prostate cancer grows from the posterior (back) peripheral zone of the prostate.

-Lef

[leflauren678]

So I think it means we should get as many screens as we can!!

This is a very common medical misconception. More tests does NOT mean more accurate results.

Getting lots of screens that have high false-positives, just means that you are more likely to have a false-positive result. And here in the US, if you have a positive test results, it almost definitely means biopsy and then surgery.

Biopsies cause scaring and can make it more difficult to later remove the prostate if in fact you develop cancer. They also tend to lead down a path towards surgery.

Surgery causes incontinence and impotence.

While we wish we had better screening methods for prostate cancer, but the PSA does more harm than good. The fact is that most men with prostate cancer die of other causes before the prostate cancer affects their health. And that most positive PSAs are false-positives.

http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm

-Lef