This past summer, I was diagnosed with prostate cancer. For more than three decades, I have taught, examined, and guided patients through various types of illnesses. However, nothing prepared me for the disorienting effect of becoming a patient myself. The diagnosis itself (a less aggressive prostate cancer amenable to robot-assisted radical prostatectomy) felt, at first, like a technical problem with a straightforward surgical solution. But what I did not fully appreciate at the time were aspects of moral and clinical responsibility that begin after the surgeon’s sutures are tied. The patient perspective gave me insight into the doctor’s responsibility to shepherd recovery, to help in the healing process of what the scalpel has altered and, critically, to attend to the intangible losses a person experiences when their body no longer behaves as it used to.

In my case, the immediate and efficient struggle following my surgery was urinary incontinence. As a physiatrist, I initially assumed that I would leverage my medical experience to expedite my own healing process. I quickly found that this assumption was very naive. But, at the same time, I found it incredibly instructional. Months of wearing adult incontinence products and the recurring irritation of failed expectations resulted in a growing irritability. I finally recognized that my overconfidence in my professional background had resulted in a blind spot in my situation. My frustration was not solely based on physical limitations or the reality of a slow healing process. What I had not initially recognized was the erosion of dignity and autonomy resulting from a medical procedure. And this recognition made me confront how medicine can minimize the consequences of complications patients endure, many times in silence.

My first appointment with physical therapy shattered the illusion that anatomical knowledge equated to functional mastery. Under the guidance of a skilled pelvic floor physical therapist and with the aid of biofeedback, I learned that the pelvic floor is not an abstract anatomical region, but a dynamic, often dormant, motor system. Despite years of teaching gross anatomy and rehabilitation principles, I had not internalized how rarely most men recruit these muscles and how technically precise activation must be done to restore continence and sexual function. Biofeedback turned vague instructions into measurable, repeatable contractions. That empirical feedback changed everything, in that my efforts, under specialized instruction, became targeted and measurable. The simple transition to progress quantification transformed into a hope of recovery.

This personal experience prompted me to reconsider how we typically train and practice in the medical field. Why do we assume that patients, or physicians who become patients, will instinctively know the muscles that matter? Why is pelvic floor rehabilitation an afterthought in perioperative planning when its absence predictably produces months of avoidable disability? These are not rhetorical questions but thought-provoking questions. We take pride in our precision in the operating room. Precision during recovery should demand the same standard.

The consequences of neglecting pelvic floor rehabilitation are profound. Urinary incontinence after prostatectomy is more than a temporary nuisance. It is a mediator of social withdrawal, of altered intimate relationships, and of identity disruption. Men describe embarrassment that limits social engagement, anxiety around travel, and the constant recalibration of daily routines to manage leakage. Sexual dysfunction (often attributed to nerve injury alone) intersects with pelvic floor weakness in ways our discharge summaries rarely address. The pelvic floor supports erectile rigidity and orgasmic function. Strengthening and retraining this musculature can meaningfully influence sexual recovery, yet we rarely frame preoperative counseling around these outcomes with clarity and specificity.

Our clinical pathways must change to achieve holistic recovery. Prehabilitation is not a luxury. It is a clinical intervention. I recommend initiating pelvic floor training 4-6 weeks before surgery. This interval allows motor learning, neuromuscular recruitment, and patient confidence to grow before the insult of surgery. Practical preoperative 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. The language we use matters: rather than offering vague directives (“do kegels”) we must provide a practical and reproducible program with measurable goals.

Postoperative timing and oversight matter equally. Starting PFEs 7-10 days after surgery is optimal, naturally, if wounds permit it and catheter removal is complete. This balances safety with the urgency of retraining. Early and supervised therapy prevents compensatory patterns that can harden into chronic dysfunction. Clinicians must resist the common practice of delegating this phase entirely to patients with a pamphlet and a box of incontinence pads. Recovery is a collaborative and iterative process. Physical therapists, urologists, primary care physicians, and patients must form a team with shared metrics and clear follow-up milestones.

Beyond scheduling, we must reassess how outcomes are measured. Too often, success is binary (pad-free or not) when the reality of recovery follows a gradient. We should adopt patient-centered metrics that capture functional gain, disruptions, and quality of life. Simple validated questionnaires administered serially, combined with objective measures where possible, would illuminate trajectories and help tailor interventions. Normalizing conversations about continence and sexual health in clinic notes and multidisciplinary rounds dismantles stigmas and shows patients that these outcomes matter professionally as much as oncologic control.

Education is the lever for cultural change. We must embed pelvic floor rehabilitation into surgical consent discussions and residency curricula. Trainees need to see recovery as part of the procedure’s overall contract. Urology and rehabilitation programs should collaborate to create standardized modules that teach not only anatomy and exercises but also communication skills for discussing incontinence and sexual health with sensitivity. When clinicians model frank, normalized conversations, patients are more likely to engage with prehabilitation and follow-up care.

My transformation from clinician to patient revealed another lesson: humility in the face of embodied experience sharpens clinical practice. It is easy to counsel a patient to “do kegel exercises” while treating the details of implementation as trivial. It is another thing to try and fail, to feel the indignity of leakage, and to discover that the correct sequence of contraction and relaxation requires coaching. Empathy, informed by procedural knowledge and guided practice, becomes the force multiplier for healing.

The ethical imperative is clear: 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. Prehabilitation, early supervised rehabilitation, robust outcome measurement, and curricular reform are not optional extras; they are essential components of patient-centered prostate cancer care.

I urge my colleagues to reframe success in prostate cancer treatment. Cure must be paired with restoration. Let us commit to integrating pelvic floor expertise into perioperative pathways, to teach it rigorously, and to discuss it directly but with empathy. If we do, we not only improve recovery metrics. We also honor our patients’ dignity and rebuild the confidence surgery so often takes away. My recovery continues to be a work in progress, but data, discipline, and teamwork now guide it; principles we already teach and must now apply to the entire care continuum.

Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness. 

Dr. Torres was born in Spain and grew up in Puerto Rico. He graduated from the University of Puerto Rico School of Medicine. Dr. Torres performed his physical medicine and rehabilitation residency at the Veterans Administration Hospital in San Juan before completing a musculoskeletal fellowship at Louisiana State University Medical Center in New Orleans. He served three years as a clinical instructor of medicine and assistant professor at LSU before joining Florida Spine Institute in Clearwater, Florida, where he is the medical director of the Wellness Program.

Dr. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. He is a prolific writer and primarily interested in preventative medicine. He works with all of his patients to promote overall wellness.