Dr. Joseph Chin recommends regular prostate cancer testing for men over 50.

London city councillor Harold Usher had his world turned upside down by a diagnosis of prostate cancer in 1998.

In January of 1998, Harold Usher --engineer, human-resources trainer and city councillor in London, Ont. -- had his world turned upside down.

The impetus for this transformation was a diagnosis of prostate cancer, something that more than 22,000 Canadian men will experience this year.

Today, prostate cancer is the leading cancer diagnosis in men and, in Canada, the number three killer, threatening to surpass number two -- colon cancer. It's also a cancer than can range from slow-growing to aggressive, resulting in a variety of treatment options from active surveillance -- no immediate therapy but careful monitoring -- to radiation or surgery.

What to do, that's the big question facing patients. In Usher's case, he did nothing. For two years. "I went into denial," he says. "I didn't want to deal with it."

It's not a course of action he recommends but he believes it's not uncommon. "Many men have told me they did the same thing."

His urologist, Dr. Joseph Chin, professor and chair of the division of Surgical Oncology at the University of Western Ontario and head of a regional surgical oncology program, agrees. "It's pretty common. It's reluctance, inertia, sometimes ignorance, sometimes fear."

And, in cases of advanced or aggressive cancer, a long wait can be detrimental, he says. There are some prostate cancers that are extremely slow-growing and can be monitored over time -- a strategy that used to be called "watchful waiting."

But, says Chin, "we have to be very selective and very careful about whom we watch." In fact, he says, there is an international study underway -- London is one of the sites -- to determine whether this is ever a safe approach. Patients who satisfy a rigid criteria are randomized to receive surgery or to be monitored with regular blood tests, ultrasound and follow-up biospsies.

When he was diagnosed, Usher did not qualify for "watchful waiting." But for six months he simply ignored the situation. At that point, he says, his wife told him, "You'd better get some books and find out about this." So he visited the London Health Sciences Centre library and came home with two books and two tapes, which he did not read or listen to.

Fortunately, his wife did. She also accompanied him to his next appointment with Chin. Surgery was the recommendation but Usher was reluctant. For the next several months, he read up on the condition and investigated various alternative therapies, from vitamins to naturopathy. Eventually he decided to go ahead with the surgery and, seven years later, is cancer-free. Although he considers himself lucky, he's taking nothing for granted and continues annual testing..

"The big scenario is that if you ask questions, you will get answers. But you have to know the questions. I didn't have a clue what to ask," he says. "And that can lead to a dangerous situation. You could have an aggressive cancer eating away at you."

His situation led him to write a book about his experience and incorporating the information he discovered in his quest, from healthy-lifestyle advice to detailed information on prostate cancer, how it is diagnosed and evaluated, and the various treatments available. Prostate, Prostate, Prostate -- A Problem of Men is slated for publication this spring.

Reading about the prostate gland is good advice, Chin suggests, but while the internet is one possible source of information, it contains good and not-so-good advice so information gained there should be brought back to a trusted doctor or specialist for discussion.

Early detection is critical, says Dr. Edward Matsumoto, urologist at Hamilton's St. Joseph's Health Centre.

"If you're in your 40s or 50s and diagnosed with prostate cancer, you have a greater than 10-year life expectancy. There's a good chance that if you leave the cancer alone, it will cause problems in your lifetime," he says. "That's why I look at it as a young man's disease. You have to be aggressive with the younger guys and even in some older guys, if they're fit and healthy.

Chin says increased awareness today is resulting in more men asking their doctors for testing. He maintains that men between the ages of 50 and 70 should have regular PSA blood tests (prostatic specific antigen, a blood marker that is one indication of the presence of cancer) and, as part of their annual physical check-ups, rectal examinations, the test that initially identified a suspicious lump in Usher's prostate.

To help men understand their diagnosis, the Prostate Cancer Foundation of Canda offers a set of online Assessment Tools. Users need information from a doctor such as biopsy results and results should be taken back to the doctor for discussion.