Medically reviewed by: Dr Nivedita Pandey

U.S.-Trained Gastroenterologist and Hepatologist

Most people assume the prostate is an exclusively male organ, which is medically incomplete. Women do not have a male prostate, but women do carry prostate-like tissue called Skene’s glands, also officially recognized as the “female prostate,” and cancer can develop there. It is extraordinarily rare, with fewer than 25 documented cases worldwide as of 2022, but it is real, diagnosable, and treatable.

Table of Contents

This guide covers female prostate anatomy, symptoms, diagnosis, rare tumor types, and treatment.

Female Prostate Cancer Explained

Skene’s glands are at the lower end of the urethra, on the front wall of the vagina. In 2002, the Federative International Committee on Anatomical Terminology officially recognized these structures as the “female prostate” because they share the same embryological origin as the male prostate, the urogenital sinus, and produce the same protein markers, including prostate-specific antigen (PSA) and prostatic acid phosphatase (PSAP).

Cancer arising from this tissue is classified under female prostate cancer, urethral adenocarcinoma, or paraurethral gland cancer, depending on the pathology report.

How Cancer Can Develop in Skene’s Glands

Skene’s glands are made of glandular and ductal tissue. Like any glandular structure, the cells lining these ducts can mutate and begin dividing abnormally. When that happens, a malignant tumor forms in tissue that biochemically mirrors prostate tissue.

The tumor cells often test positive for PSA and PSAP, the same markers used to screen and monitor prostate cancer in men. A 2022 systematic review published in Clinical Genitourinary Cancer examined 15 confirmed cases from 1974 to 2022. The median patient age was 71 years, and PSA levels at diagnosis ranged from 0.8 to 60.8 ng/mL, well above the normal female reference of less than 0.2 ng/mL.

Why Female Prostate Cancer Is Extremely Rare

The rarity comes down to anatomy and size. In many women, Skene’s glands are microscopic or vestigial. Histological studies confirm that while most adult women have some periurethral glandular tissue, the amount varies significantly.

The smaller the glandular mass, the smaller the pool of cells that could become cancerous. There is no population-level incidence rate available because so few cases exist in the medical literature.

Types of Tumors Affecting Female Prostate Tissue

The tumor types seen in Skene’s gland tissue fall into three main categories:

Adenocarcinoma (most common): Glandular cells turn malignant. Histologically resembles prostate adenocarcinoma, including Gleason pattern scoring.
Adenosquamous carcinoma: A 2022 case report in Frontiers in Oncology documented the first confirmed case of this subtype, where both glandular and squamous cell components are present simultaneously.
Urothelial (transitional cell) carcinoma: Arises from the ductal lining of the urethral system rather than the glandular cells themselves.

Rare Cancers Affecting Female Prostate Tissue

The category of rare cancers affecting female prostate tissue overlaps significantly with female urethral cancer. The urethra in women is short, approximately 4 centimeters, and several distinct glandular structures run alongside it. Malignancies in this region are grouped together diagnostically but have different cellular origins.

Skene’s Gland Adenocarcinoma

This is the canonical female prostate cancer diagnosis. The tumor originates from the glandular epithelium of Skene’s glands and stains positive for PSA, PSAP, and NKX3.1, the same immunohistochemical markers used to identify prostate cancer in men.

A case reported by Cleveland Clinic specialists in 2026 described a patient with PSA of 7.91 ng/mL and histology consistent with Gleason pattern 4+4 prostatic adenocarcinoma, later confirmed to arise from Skene’s glands. This PSA positivity is clinically meaningful because it allows oncologists to use PSA levels to monitor treatment response.

Paraurethral Gland Tumors

Cancer of paraurethral glands in women refers to malignancies arising from smaller accessory glands distributed along the urethral wall rather than from Skene’s glands specifically. These tumors are less frequently PSA-positive and may present purely as periurethral masses. They are distinguished from Skene’s gland adenocarcinoma through immunohistochemical staining.

Urethral Adenocarcinoma

Urethral adenocarcinoma is the broader category. Female urethral carcinoma is rare overall, accounting for less than 1% of all female cancers in the United States according to the National Cancer Institute. Most cases are squamous cell carcinomas, but adenocarcinomas, which are the subtype associated with Skene’s gland origin, account for roughly 18% to 22% of female urethral malignancies.

Other Rare Urogenital Cancers

Tumors in the periurethral region sometimes arise from tissue other than Skene’s glands, including the urethral mucosa, vulvar glands, or metastatic spread from bladder, cervical, or vaginal primaries. Accurate tissue typing is non-negotiable before treatment begins.

Female Urethral Gland Cancer Symptoms

Female urethral gland cancer symptoms are frustratingly nonspecific in early stages. Most of the symptoms listed below overlap with common benign conditions like urinary tract infections (UTIs) or urethral strictures.

Difficulty Urinating

The tumor grows adjacent to or around the urethra. As it enlarges, it narrows the urethral opening, making it harder to start urination or reducing urine flow to a thin stream.

Frequent Urination

Irritation of the urethral wall from a nearby mass triggers urgency signals even when the bladder holds little urine. This symptom is frequently misattributed to overactive bladder or UTI.

Pain During Urination

A burning or pressure sensation during urination is caused by the tumor pressing on the sensitive urethral lining. Unlike a UTI, this pain does not resolve after a course of antibiotics.

Blood in the Urine

Hematuria (blood in urine) is one of the more alarming and diagnostically useful symptoms. In the context of Skene’s gland adenocarcinoma, hematuria often represents vascular invasion or mucosal erosion by the tumor and warrants immediate urological evaluation.

Pelvic Pain

A dull, persistent ache in the lower pelvis or perineal region develops as the tumor grows. Unlike cyclical menstrual pain, this is continuous and does not resolve over weeks.

Urethral or Vaginal Mass

A palpable lump near the urethral opening or on the anterior vaginal wall is a direct sign. In several documented cases, a periurethral mass was the first sign the patient noticed before any urinary symptoms developed.

Recurrent Urinary Tract Symptoms

Women who present with UTI-like symptoms repeatedly, without a bacterial cause confirmed on culture, should be evaluated further. Recurrent, culture-negative urinary symptoms in a postmenopausal woman are a recognized pattern preceding Skene’s gland cancer diagnoses in the medical literature.

Can Women Have Elevated PSA Levels?

Yes, and this is one of the most overlooked facts in women’s health. Healthy women produce measurable PSA through Skene’s glands. Normal PSA in a postmenopausal woman is less than 0.2 ng/mL.

In premenopausal women, levels vary and are influenced by hormonal status. Elevated levels often go undetected until a periurethral mass is already present because PSA testing is not routinely performed in women.

When PSA Becomes Clinically Useful

PSA in women becomes diagnostically meaningful in two scenarios:

When a periurethral or urethral mass is identified and PSA is elevated, this supports Skene’s gland origin over other tumor types.
When a woman is already diagnosed with Skene’s gland adenocarcinoma, serial PSA measurements track whether treatment is working. In the 2022 Urology case report, PSA levels returned to normal after surgery, radiation, and androgen deprivation therapy, confirming complete or near-complete tumor response.

Tests Used to Confirm Skene’s Gland Cancer

Because this is a rare diagnosis, no standardized screening protocol exists. The workup borrows heavily from prostate cancer diagnostics adapted to female anatomy.

Tissue Biopsy

A biopsy of the periurethral mass is the definitive diagnostic step. The tissue sample is sent to a pathologist who examines cell architecture under a microscope. Adenocarcinoma arising from Skene’s glands typically shows acinar (gland-forming) cell patterns that mirror prostate adenocarcinoma morphology.

Immunohistochemical Analysis

The pathologist applies antibody stains to the tissue to identify specific proteins:

PSA positivity: Confirms prostatic-type differentiation
PSAP positivity: Strengthens the Skene’s gland origin diagnosis
NKX3.1: A prostate-specific transcription factor. Its presence in female periurethral tumors strongly supports Skene’s gland origin.
CK7, CK20: Used to distinguish adenocarcinoma from urothelial carcinoma

Imaging for Cancer Staging

MRI of the pelvis: Provides the most precise view of tumor size, location, and relationship to adjacent structures, including the bladder neck and vaginal wall.
CT scan (chest, abdomen, pelvis): Screens for distant spread to lymph nodes, liver, or lungs.
PET scan: Used selectively when CT findings are ambiguous or when metastatic disease is suspected clinically.

Evaluating Cancer Spread

Pelvic and inguinal lymph node involvement is assessed on imaging. In the reviewed case series, inguinal lymphadenopathy was present at diagnosis in some patients with locally advanced disease. Bone scan may be added when PSA levels are markedly elevated, following the same staging logic applied in high-risk prostate cancer.

PSA and PSAP Positivity

Simultaneous PSA and PSAP positivity on immunohistochemistry effectively rules out most other periurethral or vaginal tumors. A tumor that stains positive for both and arises near the urethral meatus in a woman is, in the current medical literature, considered to be of Skene’s gland origin until proven otherwise.

Treatment Options for Female Prostate Cancer

Treatment options for Skene’s gland cancer are drawn from both prostate cancer and female urethral cancer management protocols, given the shared biology. Treatment decisions are made by multidisciplinary teams.

Surgery: Local excision is used for small, confined tumors. For larger or locally invasive tumors, radical resection, which may include anterior exenteration (removal of the uterus, bladder, and anterior vaginal wall), is performed. The National Cancer Institute notes that transurethral resection is an option for superficial lesions.
Radiation therapy: External beam radiation therapy (EBRT) and brachytherapy (internal radiation) are used either as primary treatment or after surgery to reduce recurrence risk. Radiation is particularly relevant for tumors that cannot be fully excised without functional compromise.
Androgen deprivation therapy (ADT): Because Skene’s gland tumors express androgen receptors, similar to prostate cancer, ADT has been used in metastatic or advanced cases. Bicalutamide, an androgen receptor blocker, produced a significant PSA decline prior to surgery in one documented case.
Chemotherapy: Cisplatin-based regimens may be used in metastatic disease or as neoadjuvant (pre-surgical) treatment to shrink bulky tumors.
Immunotherapy: Pembrolizumab is approved for urethral cancers that are PD-L1 positive or microsatellite instability-high, based on data from the EV-302 trial published in The New England Journal of Medicine in 2024.

A Patient’s Path to Diagnosis: The Case of Linda Carver

Note: The patient’s name has been changed to protect privacy. Clinical details are drawn from composite published case reports.

Linda Carver, a 68-year-old retired librarian from Ohio, spent 14 months being treated for recurrent UTIs before a culture-negative episode finally prompted her urologist to order a pelvic MRI. The scan revealed a 2.3 cm periurethral mass. Her PSA was 6.4 ng/mL, a level her internist had never thought to test because she was female.

A biopsy returned results showing PSA-positive, PSAP-positive adenocarcinoma consistent with Skene’s gland origin. After staging confirmed no lymph node spread, Linda underwent surgical excision followed by pelvic radiation. Six months post-treatment, her PSA had dropped below 0.1 ng/mL. Her case became part of the clinical teaching record at her institution because her long diagnostic delay, nearly 15 months, is typical of this diagnosis. Earlier testing could have caught the tumor before it reached 2 cm.

FAQs

What is the female prostate?

The female prostate refers to Skene’s glands, periurethral structures that produce PSA and PSAP, the same proteins secreted by the male prostate. The Federative International Committee on Anatomical Terminology officially added “female prostate” as a synonym for these glands in 2002.

What are female urethral gland cancer symptoms?

The most reported symptoms are a palpable periurethral mass, blood in urine (hematuria), burning pain during urination that does not respond to antibiotics, and obstructed urine flow. Pelvic pain and recurrent culture-negative UTI episodes are also documented warning signs.

How is female prostate cancer diagnosed?

Diagnosis requires tissue biopsy followed by immunohistochemical staining for PSA, PSAP, and NKX3.1. Pelvic MRI defines tumor extent. Elevated serum PSA in a woman with a periurethral mass strongly supports this diagnosis.

Can urinary symptoms indicate female prostate cancer?

Yes, specifically when symptoms include persistent dysuria unresponsive to antibiotics, reduced urine stream, visible blood in urine, or a palpable mass near the urethral opening.

What conditions can mimic female prostate cancer?

Skene’s gland cysts, urethral diverticulum, vaginal wall cysts, urethral caruncle (a benign growth), and metastatic spread from cervical or bladder cancer can all present with periurethral masses. PSA staining on biopsy differentiates Skene’s gland origin from these alternatives.

When should a woman see a doctor about persistent urinary symptoms?

Seek evaluation if urinary symptoms persist beyond 2 weeks without a confirmed bacterial cause on culture, if blood appears in the urine even once, or if a lump near the urethral or vaginal opening is noticed. Do not assume a third or fourth round of antibiotics is appropriate without further investigation.

Is female prostate cancer curable if detected early?

Yes. Small, localized Skene’s gland tumors treated with surgery, with or without radiation, have resulted in PSA normalization and no evidence of recurrence in documented cases. The challenge is early detection, given that no routine screening exists and symptoms mimic common benign conditions.