September has been unofficially designated as Prostate Cancer
  Awareness (PCA) Month and the week of September 15-22, 2002
  has been set aside as Prostate Cancer Screening Week by many
  major hospitals, where free blood tests and prostate examinations
  will be provided by experienced Urologists. In view of this major
  health event, I am resubmitting a prior TG Forum article detailing
  why it is important to attend these screenings. If you take into
  account that about 200,000 new cases of Prostate Cancer will be
  diagnosed in the USA this year and approximately 32,000 people
  will die this year from advanced Prostate Cancer, making it the
  second most lethal organ cancer next to Lung Cancer, you may
  understand why you should take this seriously. The following
  article details the relationship of the TG Community to PCA.

  We are surely familiar with the acronyms HRT for hormonal
  replacement therapy and SRS for sex reassignment surgery, but
  not as familiar with the acronym PSA, Prostate Specific Antigen.
  But if you are over 40 years of age and carry a Y-chromosome as
  in a genetic male, you should be aware of your PSA even though
  you may have undergone HRT and SRS. Bob Dole can thank his
  lucky star that he knew his PSA early enough to save his life and
  become a spokesperson for ED, erectile dysfunction, and Viagra.
  PSA is a protein produced by all prostate tissue, benign and
  malignant, and generally increases in the bloodstream with age.
  The prostate is a small accessory sex organ which surrounds the
  urinary channel, the urethra, and resides just outside the bladder.
  It functions primarily as a conduit providing essential life
  sustaining chemicals for sperm as they leave the body. So who
  needs it you say. Well certainly no one who has undergone MTF
  SRS. But the point is that to remove the prostate requires
  extensive surgery, which is not done at the time of SRS.
  Therefore we must the deal with the implications of having this
  organ for the rest of our lives whether we have had SRS, HRT or
  no medical intervention.

  The prostate begins as a small walnut-size organ that increases in
  size with the onset of puberty and continues to grow under the
  influence of testosterone (T) and its metabolite
  dihydrotestosterone(DHT). This growth pattern may be
  accelerated by the use of exogenous T and anabolic steroids as
  used by Mark Maguire and other athletes. Conversely the prostate
  will shrink with the use of exogenous estrogens and their
  metabolites in the HRT population. In the absence of either
  therapy, the central portion of the gland will grow in
  approximately 80% of males to where there is some restriction in
  urinary flow after the age of 50. This condition, benign prostatic
  hypertrophy (BPH) has been reported in MTF transsexuals,
  occasionally requiring surgery, after a trial of alpha blockers,
  which may improve urinary flow. PSA will increase slowly from
  year to year with BPH and decrease to approximately one-third of
  normal with maximum HRT. But it is essential that a baseline
  PSA number be established for annual comparisons.

  From age 20, the prostate can make itself known to us as a
  reservoir for bacterial infection. Acute prostatitis brings
  symptoms of urinary frequency, burning and urgency as a bladder
  infection would manifest itself in a woman. There may also be
  fever and discomfort in the perineum, where we sit. While acute
  prostatitis occurs in about 20% of men, this condition will
  become more frequent after the urethra is shortened at the time of
  SRS. Acute and chronic prostatitis is usually amenable to
  antibiotic therapy, but can become an unrelenting problem for
  some. Since typical bacterial and chlamydial organisms can rarely
  be recovered from the prostate or urethra in chronic prostatitis,
  the exact cause of this problem remains unknown. Because PSA
  becomes markedly elevated with the onset of prostatitis, blood
  levels should not be determined until 2 months following the
  cessation of symptoms.

  The more insidious growth of prostate cancer (PCA) has made it
  the most common cancer in the U.S. male population and the
  second most deadly. One of the proven therapies for PCA has
  been the introduction of total androgen blockade either by
  castration or the introduction of female hormones to induce both
  pituitary and testicular blockade of T and DHT production. So
  you would think that a MTF transsexual (TS) would be protected,
  but that does not seem to be the case. It appears that the salutary
  effects of this hormonal manipulation last only 3-5 years, before
  hormonally resistant PCA reappears and resumes its prior growth
  rate. PCA has been reported in TS's years after the initiation of
  feminizing hormones. It has been the feeling of medical
  researchers, that by extrapolation of known prostatic cancer
  growth factors, the cancer requires approximately 10 to 15 years
  to become clinically manifest. So here is where knowing your
  PSA can save your life. If you start early and continue annually to
  follow your PSA, you can usually predict the early growth of
  PCA before it becomes too late to cure. The test is good and
  many refinements have been made in the past 10 years, but it is
  not perfect. A normal range of 0 - 4.0 has been established for the
  population under the age of 65. This range is then age-adjusted
  and has an accepted annual increase of seventy-five/one
  hundredths, .75 per year. A lower normal range has been
  established for the black population as there appears to be a
  higher incidence of PCA becoming clinically manifest at an
  earlier age. It is the recommendation of the American Cancer
  Society (ACS) that annual PSAs be drawn annually beginning at
  age 50 and beginning at age 40 in the black population or anyone
  with a family history of PCA on either his mother or father's side.
  This is because a PCA dominant gene has been identified in a
  small but distinct group of PCA patients. The ACS also
  recommends an annual rectal exam at the time of your PSA in
  order to detect any hard prostatic nodules, that might not be
  evident from your PSA result. Sorry, but I said "Not Perfect." It
  appears that approximately 20% of all detected PCA will have a
  PSA in the normal range. This is still a high number, but newer
  and more sensitive PSA tests as Free PSA have been introduced
  to reduce this number. Secondly Prostate Specific Antigen does
  not seem to be as organ specific as earlier thought. It appears that
  this protein has been detected in approximately 30% of all female
  breast cancers, in the testicular tissue of MTF's and in the breast
  tissue of FTM transsexuals treated with androgens. As you can
  see this a new book, whose chapters are being written daily, but
  your PSA can afford insight into a disease, PCA, which can be
  cured in over 90% of the cases that are detected early.

  Best Wishes in Your New Future,
  Cerise Richards, M.D.