September is national prostate cancer awareness month. And I've been thinking about it for days.

Prostate cancer is the most prevalent form of cancer after skin cancer, and it is the second leading cause of cancer-related deaths in men in the US. Dozens of men in Rochester will learn that they have prostate cancer this month. And I'm betting the news will be a bewildering surprise.

Welcome to what some men are calling the "dark forest" of cancers.

As prevalent as prostate cancer is, it's still mysterious and a bit devilish. Conflicting studies are reported almost monthly. On one hand, aggressive forms of prostate cancer can overwhelm the body quickly. Others can dilly-dally for years.

Unfortunately, how ferocious the cancer will be isn't very predictable. It's a game of musical chairs, and no patient wants to be caught without a seat.

And there is some evidence that prostate cancers are being over-treated by a crop of urologists-turned surgeons.

The problem is even the most skilled surgeons have difficulty preventing the dreaded aftereffects of a radical prostatectomy: incontinence and impotence. While these problems don't happen to everyone, removing a man's prostate is a radical decision.

The physical and psychological changes are unmatched even in the precarious world of cancer.

As I've written before, I was diagnosed with advanced prostate cancer over a year ago and I underwent a prostatectomy. For months afterward I would ask myself, "Why me; what did I ever do to deserve this?"

Now that little voice asks, "Did you really need surgery?"

Since I was diagnosed, I've grown used to the CAT Scan's hammer and peed in more plastic cups than you can imagine. I've had enough blood drawn to fill my neighbor's pool.

And in July, I underwent a procedure to determine if the cancer had spread to my bladder or kidneys. Fortunately, the tests all came back negative.

Vigilance is a skill that cancer survivors must learn quickly. But somewhere along the way, I've forgotten what I'm looking for and what I'm guarding against.

Campaigns about prostate cancer awareness are certainly important. Men approaching their late 40's or early 50's should become familiar with their PSA stats, especially if they know their father or grandfather has had prostate cancer.

But more research is needed to help address the growing questions surrounding treatment options.

Otherwise, more and more men will spend years wandering the dark forest in search of answers.