Here are some facts that I would like you to know about the prostate, prostate cancer, and prostate cancer screening.

What is the prostate?

It is a gland that men have deep in their lower pelvis, between their bladder and rectum. It is usually about the size of a plum and makes a lot of the liquid that becomes part of their semen. A rectal examination can feel the outside portion of about a third of the gland.

Prostate cancer is common. And deadly.

According to the American Cancer Society, prostate cancer is the most common cancer in men (other than skin cancer). About 181,000 Americans expected to be diagnosed with it this year. This means that over the course of a man’s lifetime, he has about a 1 in 7 chance of being told that he has prostate cancer. And it tends to be an older man’s disease with about 60% of prostate cancers diagnosed in men 65 or older.

And about 26,000 men will die from prostate cancer this year. That means that more men will die from prostate cancer than any other cancer except for lung cancer. Overall, about 1 in 39 men will eventually die from prostate cancer.

But most men with prostate cancer do not die from it. They die with it.

Currently, there are about 2 million prostate cancer survivors in the US. And the survival rates for prostate cancers (combining all stages of the disease together) are almost 100% after 5 years, 98% after 10 years and 95% after 15 years.

Prostate cancer screening is not very accurate.

The only screening test we have available is a blood test called the prostate specific antigen (PSA). This is a protein that the prostate makes to help keep semen stay as a liquid. This protein is released into the blood when the prostate is irritated for any reason. This includes cancer but can also be from infections or inflammation from other things like having a lot of sex or riding a bicycle. And for reasons that are not clear, a lot of prostate cancers do not release a lot of PSA into the bloodstream. As a result the PSA is often normal in men with cancer and high in men without it.

Prostate cancer screening rarely saves lives.

It is estimated that only about 1 in 200 men who are screened for, and ultimately diagnosed with prostate cancer, actually has their life saved from screening. The other 199 would never have died from the disease but would have died from something else even though they had prostate cancer. But aggressive screening and treatment leads to a lot of worry, harm related to treatment (erectile dysfunction, urinary incontinence, rectal pain and irritation), and additional financial costs.

Prostate cancer treatment is often quite good at prolonging life – even in very advanced disease.

With some of the newer approaches to prostate cancer, including hormonal therapies and advances in chemotherapy and radiation, many men with disease that has spread throughout their body are able to go into rapid and longstanding cancer remission.

So, taken as a whole, many experts are now recommending that we do not routinely screen men for prostate cancer. I think this makes a lot of sense and I personally do not want to be screened for it until a better test is available.