Watch out, guys — this is a touchy subject.

But for many men, it’s also a life-or-death issue, and also one that doesn’t get talked about nearly enough.

It’s prostate cancer and what you do if you’ve been diagnosed — and there are a lot of options, none of which may seem very appealing.

“There’s a functional side to the prostate,” said Gainesville urologist John C. McHugh, who recently wrote a book about the issues men face when they find out they have prostate cancer. “What you thought was a simple disease of old men that no one dies of starts to be a complex issue.”

McHugh went through his own battle with prostate cancer a few years ago. He realized there was a moment, after your doctor has told you the test results and you’ve left the office, when you’re flooded with questions and fears.

“So right at that moment, they need something to read — they need a starting point,” he said, adding that he hopes “The Decision” becomes something urologists can hand to their patients as they leave the office. “The deal is, there’s 250,000 cases a year. I see three to 10 a month. It happens all the time.”

For American men, prostate cancer is the second-deadliest cancer after lung cancer. There were an estimated 27,000 deaths from it last year in the United States.

The book starts with McHugh’s own story, explaining what happens in a prostate exam and taking a look at risk factors and specifics with the disease.

When it comes to making the decision about how to treat prostate cancer, another section of the book offers a decision “cheat sheet,” a questionnaire that goes through the various risks and benefits of each method of treating prostate cancer.

Because, when you’re dealing with radiation, freezing or even removing a vital part of what helps a man urinate or have sex, it’s a big decision with potentially life-changing consequences.

“You remove the prostate and there’s the potential — there are men out there who have been treated and now they leak urine and are impotent,” he said.

Prostate cancer screening became a medical mantra in the 1990s, thanks to the development of the PSA test. But new guidelines released by the American Cancer Society warn that regular testing for prostate cancer may do more harm than good when the risks are weighed against the benefits.

The widely used test often spots cancers too slow-growing to be deadly, and treatment can lead to incontinence and impotence. Two big studies last year suggested prostate cancer screening doesn’t necessarily save lives, and any benefits can come at a high price.

The cancer society’s new guidance urges doctors to:

• Discuss the pros and cons of testing with patients, offering written information or videos that discuss the likelihood of false test results and the side effects of treatment.
• Stop routinely giving the rectal exam because it has not clearly shown a benefit, though it can remain an option.
• Use past PSA readings to determine how often follow-up tests are needed and to guide conversations about treatment.
• Some doctors and advocates are troubled by the new guidelines.

“Prostate cancer is still something to be respected if not feared, and we still need to be vigilant. I hope primary care docs or insurance companies don’t use the ‘softening’ of the guidelines as an excuse to not do screening at all,” said Dr. David Roberts, medical director of an Atlanta clinic that caters to businessmen.

Men will need to weigh their fear of having a potentially aggressive cancer versus treatment that can cause ugly side effects.

Another option if cancer is found is watchful waiting — that is, doing nothing — but that can mean high anxiety.

And all of these options are weighed in McHugh’s book.

In a sense, prostate cancer for a man can be compared with a woman’s diagnosis of breast cancer. The decision process is the same, McHugh said, but everyone knows about breast cancer and its emotional and physical effects — whereas a prostate is something you don’t see, and its role is unintentionally lessened.

“But it has a functional side that makes the decision of what to do terrible,” he said.

And because men often avoid the prostate exam to begin with, prostate cancer quickly can go from the slow-moving kind to something that progresses fast.

“Men don’t have a rectal exam until they’re 50, and they don’t like it,” he said. “I call that ‘the perfect storm.’ It’s the exam they don’t want and the flawed misconception that it won’t work, leads to the perfect storm.”

The Associated Press contributed to this story