A doctor's own prostate cancer recovery

A doctor's own prostate cancer recovery

NEWSLETTER ARTICLE

From Doctor to Patient: A Physiatrist's Journey Through Prostate Cancer Recovery Highlights Critical Gap in Pelvic Floor Rehabilitation

Growing Evidence Supports Comprehensive Prehabilitation and Early Intervention Programs

For the IPCSG Newsletter

When Francisco M. Torres, MD, an interventional physiatrist specializing in spine-related pain syndromes, was diagnosed with prostate cancer this past summer, his three decades of medical experience did not fully prepare him for what followed. His journey from physician to patient has illuminated a significant gap in prostate cancer care that recent research confirms affects thousands of men annually: the systematic neglect of pelvic floor rehabilitation in perioperative planning.

Dr. Torres underwent robot-assisted radical prostatectomy for his less aggressive prostate cancer. What he discovered during his recovery has prompted him to advocate publicly for fundamental changes in how the medical community approaches post-surgical rehabilitation, particularly regarding urinary continence and sexual function recovery.

The Personal Impact

"Nothing prepared me for the disorienting effect of becoming a patient myself," Dr. Torres wrote in a recent essay published on KevinMD. Despite his extensive medical training and experience in rehabilitation medicine, he found himself struggling with urinary incontinence for months, wearing adult incontinence products and experiencing what he described as "a growing irritability" from failed expectations.

The turning point came when Dr. Torres recognized that his frustration stemmed not just from physical limitations, but from an erosion of dignity and autonomy resulting from the medical procedure—a realization that forced him to confront how medicine often minimizes the consequences of complications patients endure, frequently in silence.

The Role of Specialized Physical Therapy

Dr. Torres's first appointment with a skilled pelvic floor physical therapist, aided by biofeedback technology, shattered his assumption that anatomical knowledge would translate to functional mastery. He learned that the pelvic floor represents a dynamic, often dormant motor system that most men rarely recruit, and that technically precise activation is essential for restoring both continence and sexual function.

This personal experience aligns with mounting scientific evidence. A 2025 systematic review and meta-analysis published in European Urology Focus examined 14 randomized clinical trials and found that pelvic floor muscle training with preoperative biofeedback significantly reduced postprostatectomy incontinence at multiple follow-up periods, with an odds ratio of 0.51 up to three months following surgery.

Recent Research Confirms the Urgency

Multiple systematic reviews published in 2024 and 2025 have strengthened the evidence base for comprehensive pelvic floor rehabilitation:

A systematic review published in BMC Urology in September 2024 analyzed clinical trials involving 642 participants and concluded that pelvic floor prehabilitation before radical prostatectomy aims to improve urinary continence, sexual function, and quality of life. The review found that treatments combining pelvic floor exercises with aerobic and resistance training showed better functional recovery and continence outcomes.

Another comprehensive systematic review published in the Journal of Cancer Survivorship in August 2025 examined 20 randomized controlled trials involving 2,444 participants. The study evaluated structured and supervised pelvic floor muscle training delivered pre- or postoperatively, with or without biofeedback, and found significant benefits for symptom severity and continence-related quality of life.

The Scope of the Problem

In Spain alone, prostate cancer is expected to be the most frequently diagnosed cancer in men in 2025, with an estimated 32,188 new cases. An estimated one in eight men in Spain will be diagnosed with this disease, with 90% of patients being over 65 years old.

The consequences of neglecting pelvic floor rehabilitation are profound. Urinary incontinence after prostatectomy functions as a mediator of social withdrawal, altered intimate relationships, and identity disruption. Men report embarrassment limiting social engagement, anxiety around travel, and constant recalibration of daily routines to manage leakage.

Sexual Function Recovery Often Overlooked

Sexual dysfunction, often attributed solely to nerve injury, intersects with pelvic floor weakness in ways discharge summaries rarely address. The pelvic floor supports erectile rigidity and orgasmic function, and strengthening and retraining this musculature can meaningfully influence sexual recovery.

A 2024 systematic review on conservative treatment of sexual dysfunction among men undergoing prostate cancer treatment, published in Sexual Medicine Reviews, examined various physiotherapy interventions and found evidence supporting pelvic physical therapy for male sexual disorders.

Research published in Frontiers in Oncology examining sexual prehabilitation found that starting sexual rehabilitation prior to surgery appears to ensure better erectile function recovery. The review recommended that prehabilitation should include information for both the patient and partner, with closer follow-up and use of a multimodal treatment approach including oral medication, vacuum devices, and pelvic floor muscle training.

Barriers to Implementation

Despite extensive research indicating that pelvic floor muscle training can help reduce urinary incontinence after prostatectomy, it has not been widely promoted in a significant proportion of hospitals and communities. A scoping review published in Frontiers in Oncology identified numerous barriers, including lack of common schemes in guidelines, insufficient specialized equipment for measuring electrical stimulation and biofeedback, and inadequate patient transfer and communication processes between different levels of care.

The review found that teamwork is essential for correct and standardized implementation of pelvic floor muscle training, particularly physical rehabilitation assistance, because exercise with professional interaction and motivation improves patient enthusiasm.

Dr. Torres's Recommendations for Clinical Practice

Based on his professional expertise and personal experience, Dr. Torres has issued specific recommendations:

Prehabilitation (4-6 weeks before surgery): Initiate pelvic floor training to allow motor learning, neuromuscular recruitment, and patient confidence to develop before surgery. Programs should include structured instruction, home exercise plans, and at least one supervised session with biofeedback or a trained therapist to ensure correct muscle isolation.

Postoperative Timing: Start pelvic floor exercises 7-10 days after surgery when wounds permit and catheter removal is complete. Early and supervised therapy prevents compensatory patterns that can harden into chronic dysfunction.

Team-Based Approach: Physical therapists, urologists, primary care physicians, and patients must form a team with shared metrics and clear follow-up milestones. Clinicians must resist delegating this phase entirely to patients with just a pamphlet and incontinence pads.

Outcome Measurement: Success should not be measured in binary terms (pad-free or not) when recovery follows a gradient. Patient-centered metrics should capture functional gain, disruptions, and quality of life through validated questionnaires administered serially.

The Digital Health Opportunity

Recent research published in Prostate Cancer and Prostatic Diseases in September 2025 examined digital perioperative programs combining telemedicine with surgery-specific pre- and rehabilitation modules. The study found that such programs offer promising solutions to overcome organizational constraints of traditional prehabilitation, potentially improving recovery while reducing healthcare burden and costs.

Quality of Life Considerations

A longitudinal study of 114 patients published in Nursing Reports found that 61.40% of participants experienced sexual impotence and 26.31% suffered urinary incontinence after radical prostatectomy. The study emphasized that in-depth knowledge and measurement of changes in quality of life after radical prostatectomy should allow for comprehensive, multidisciplinary, patient-centered care planning.

An umbrella review published in the Journal of Supportive Care in Cancer in November 2024 synthesized 17 systematic reviews and concluded that pelvic floor rehabilitation is an essential component of cancer survivorship following prostate, colorectal, and gynecological cancer surgery, though further high-quality primary studies are needed.

The Ethical Imperative

Dr. Torres concluded his essay with a clear ethical statement: "If an intervention as simple as targeted pelvic floor training can reduce months of disability and restore confidence, then shortchanging this part of the healing process is a form of harm. Our duty extends beyond the scalpel."

He urged colleagues to reframe success in prostate cancer treatment, emphasizing that cure must be paired with restoration. The goal should be integrating pelvic floor expertise into perioperative pathways, teaching it rigorously, and discussing it directly but with empathy.

Looking Forward

The convergence of Dr. Torres's personal experience with the growing body of research evidence creates a compelling case for systematic change. As one physician who experienced both sides of the treatment relationship concluded, empathy informed by procedural knowledge and guided practice becomes the force multiplier for healing.

For prostate cancer patients and their families, the message is clear: proactive engagement with pelvic floor rehabilitation—ideally beginning before surgery—represents an evidence-based intervention that can significantly impact recovery trajectories and quality of life outcomes.

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References

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This article synthesizes current research and clinical perspectives on pelvic floor rehabilitation for prostate cancer patients. Individual treatment plans should be developed in consultation with qualified healthcare providers.