An excerpt from Before and Beyond the Scalpel: Prehabilitation and Pelvic Floor Recovery After Prostate Cancer.

When I heard the word “cancer,” I was not prepared, and I am a physician with more than 35 years of experience.

Intellectually, I knew prostate cancer carries a high cure rate when caught early, as mine was. I understood the staging, the options, and the survival statistics. I had counseled patients through diagnoses far more frightening than this one. But none of that knowledge insulated me from the emotional ambush of those three syllables. I had watched colleagues die from cancer over the course of my career. The moment I received my own diagnosis, everything I knew as a doctor seemed to recede, and I was left simply as a man sitting with a terrifying word.

I chose robot-assisted radical prostatectomy, known as RARP. From a purely clinical standpoint, that decision was straightforward. What followed was not.

The surgery went well. The recovery did not go as I expected. I found myself dealing with painful, prolonged, and functionally debilitating side effects, complications I had not been adequately warned to anticipate. And here is what disturbed me most, not just as a patient but as a physician: I was blindsided. I, a board-certified specialist in physical medicine and rehabilitation with decades of experience working alongside physical therapists, had not known enough to protect myself. I had not known what I did not know.

That realization sent me back to the literature with a kind of urgency I had not felt in years.

Over the following months, I dove deep into the peer-reviewed research on prostate cancer diagnosis, treatment, and recovery. I studied which treatment modalities offered the best balance between survival rates and side-effect profiles. I examined the evidence on prehabilitation, the structured exercise and physical therapy work that patients can and should undertake before surgery to improve outcomes. I researched the full landscape of post-surgical rehabilitation, including pelvic floor physical therapy, urinary continence recovery, and sexual function restoration, including emerging approaches such as peptide therapies. I read everything. Then I wrote a book.

Before and Beyond the Scalpel: Prehabilitation and Pelvic Floor Recovery after Prostate Cancer is the culmination of that research, designed to be a comprehensive, accessible guide for men facing prostate cancer and their health care providers, aiming to improve outcomes and support informed decisions.

The single biggest lesson I uncovered, and the one that most humbles me, is the power of exercise and prehabilitation. I considered myself well ahead of most patients on this front. I am an athlete. I work with physical therapists every day. I thought I understood what I needed to do. I was wrong. The evidence supporting structured prehabilitation before prostatectomy is substantial and largely underutilized in clinical practice. The evidence supporting specialized pelvic floor rehabilitation after surgery is equally compelling. Yet the vast majority of patients, including me, do not receive adequate guidance in either area. This is a systems failure that is causing unnecessary suffering.

The book brings together my own experience and research alongside perspectives from oncologist Dr. Jose Alemar and pelvic floor physical therapist Dr. Gina Parsonis. Each of us brings a different vantage point to the diagnosis, treatment, and recovery process, and we have encountered the same fundamental gaps in how we prepare and support patients. Throughout the text, I link to original peer-reviewed studies because I want both patients and physicians to be able to evaluate the evidence themselves and make informed, individualized decisions, not simply take my word for it.

I want to be clear about what this book is and is not. It is not a substitute for a physician’s guidance. I repeat throughout the text, with genuine conviction, that every patient must work closely with their own doctors, disclose all supplements and treatments, and make decisions that take into account their individual medical history. But I also believe, having lived through this experience, that too many patients are handed a diagnosis and a surgery date and left to navigate an overwhelming landscape without the tools to ask the right questions. That has to change.

There is one dimension of this journey I did not anticipate writing about, and it is perhaps the most personal. In the months following my surgery, I struggled significantly with urinary incontinence. And I was ashamed.

I did not expect that. I had spent my career treating patients with functional limitations of every kind, and I believed (or thought I believed) in approaching disability without stigma. But when I was the one who needed a pad, when I was the one planning my day around bathroom access, the shame was real and visceral. At some point, I had to sit with that feeling and interrogate it honestly. Why was I ashamed of having a medical condition? I had not failed. My body had not failed me. I had undergone a major surgery to treat cancer, and I was recovering. What I eventually identified was not a personal weakness but a cultural one: the internalized ableism that most of us carry without fully examining it, and that patients deal with in silence. At the same time, physicians sometimes remain unaware of the burden.

My journey did not end with a cure. It began with a restoration of function, of self-understanding, and, unexpectedly, of a deeper empathy for what patients experience after they leave the operating room.

Medicine does extraordinary things. Robotic surgery for prostate cancer is a genuine triumph of modern medicine. But what happens afterward (the recovery of continence, of intimacy, of a man’s sense of himself), that chapter deserves the same rigor, the same evidence base, and the same clinical attention we give to the surgery itself. I hope that this book moves us a little further in that direction.

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.