After Prostate Cancer Diagnosis and Surgery or Radiation, What’s Next?

You have received the daunting news. You or one of your loved ones has been diagnosed with prostate cancer.

It is a scary, difficult time. But there are some essential things to keep in mind.

Most important, your family is not alone. According to the American Cancer Society, nearly 314,000 American males will receive a similar diagnosis in 2025.

Although it is the second most deadly type for men, behind only lung cancer, and affects one in eight males, there are more than 3.5 million survivors of prostate cancer in this country.

There are many stories of hope, especially in recent years. The American Cancer Society reports the prostate cancer death rate from 1993 to 2022 declined by about half, likely due to early detection and advancement in treatment.

Whether you or your loved one chooses surgery or radiation – the primary prostate-cancer treatments – the prognosis is often positive. And there are ways to make recovery smoother.

In honor of September as Prostate Cancer Awareness Month, two clinicians – a cancer rehabilitation physical therapist and a pelvic health physical therapist – offer insight into making a prostate cancer patient’s journey more effective.

Here are some items to consider as you go through treatment:

The side effects are real – and treatable

Removing a prostate – a walnut-shaped gland located between the bladder and rectum that serves multiple roles in the male’s reproductive and urinary systems – can create issues that men should address to maintain their quality of life.

Once a prostatectomy – the surgical removal of some or all of the prostate – occurs, urinary leakage most likely will become a side effect. Whether it is immediately following surgery or gradually with radiation, it’s usually an inevitability for those being treated for prostate cancer. The leakage won’t last forever, however, if patients undergo physical therapy sessions and continue to follow their personal care plans at home.

Pelvic health therapy – which concentrates on the group of muscles located between the pubic bone and tailbone – is designed to strengthen and/or relax that region through exercises, positioning and techniques. It can aid in limiting or ending urinary or bowel leakage as well as improve sexual dysfunction caused by pelvic floor issues.

Sexual dysfunction is also a common side effect of a prostatectomy, radiation and hormonal therapy, which may be coupled with the two primary treatments. Although the timeline for recovery varies depending on factors such as age, overall health conditions and previous sexual issues, with proper therapy, sufficient time and exercise, patients can return to a healthy sex life.

Other side effects of the treatments may include fatigue, sometimes to the extreme, as well as constipation, and, particularly with radiation and hormonal therapy, loss of muscle tone and strength.

Physical therapy is a must after prostate surgery and/or radiation. It is also highly beneficial before treatment begins. So, how do you make that happen?

Seeking prehabilitation and direct access

The most important lesson as you prepare for prostate cancer treatment is advocate for yourself. Ask questions, make suggestions, have educated, back-and-forth discussions with your urologist and cancer care team.

One of the first things you should do once you and your doctor have chosen your path of treatment is ask your urologist or family physician to prescribe a prehabilitation, or prehab, session with a physical therapist.

There are studies upon studies detailing how critical physical therapy can be for cancer patients, and most physicians recognize those benefits post-surgery. But not all are as proactive in sending patients for prehab – preparing a body with therapy before surgery or other treatment.

The good news is most doctors will support prehab sessions if requested by the patient. Even if the physicians won’t, direct access is available, at varying levels, in every state. In other words, patients can walk into a center and receive prehab physical therapy, at least initially, without needing a doctor’s prescription.

Typically, surgery or radiation won’t occur for four-to-six weeks after initial diagnosis. That gives you time for one or more prehab sessions that will provide you with personalized stretches and exercises to do at home.

There is also another huge benefit to prehab before prostate surgery: extra face time with an expert clinician.

Even the most caring urologists have limited time with their patients. It’s an unfortunate consequence of the incredibly busy profession. Therefore, literature – and sometimes, the internet – act as an addendum to a physician’s instructions or knowledge.

When you meet with a physical therapist, however, sessions typically last between 45 minutes and an hour. There, you’ll have plenty of time to ask questions of someone who deals with the recovery of similar patients every day. These specialists will not only get your body ready for treatment but your mind as well.

Concerns about leakage, incontinence or sexual dysfunction caused by prostate-cancer treatment? They will have solutions based on experience, and the time to explain the answers.

Cancer rehabilitation and pelvic health therapies and their overlap

You’re convinced physical therapy should be a part of your cancer plan. Now, which one: cancer rehabilitation or pelvic health therapy?

The right answer is both, if possible. And perhaps with the same therapist.

More than 130 clinicians in the Select Medical family of brands are certified in both specialties. Finding one with dual certification is ideal, but cancer rehabilitation therapists and pelvic health therapists often work in concert anyway, communicating throughout a care plan to make sure your treatment is seamless.

There is some overlap between the two specialties as it pertains to prostate cancer patients, but the primary difference is cancer rehabilitation is a more holistic treatment plan focused on the aftereffects of cancer, such as a decline in function, energy, mobility and balance.

Meanwhile, pelvic health therapy also focuses on conditioning and overall body wellness, but it specializes in the area that houses the prostate, and the effects caused by radiation or the gland’s removal, such as pelvic floor strengthening and bladder re-training. This therapy places an emphasis on the pelvic-floor muscles, lower back, diaphragm, abdominals, and hips.

Although the number of physical therapy sessions can vary for prostate cancer patients based on prior conditioning, type of treatment and age, experts suggest one-to-three appointments for prehab, then roughly eight visits – likely twice a week – after the procedure for either specialty. If a patient is receiving both, eight-to-12 sessions is usually sufficient initially.

For those who have had surgery, you can start physical therapy within two weeks after the procedure, once the catheter has been removed. If you choose radiation therapy for prostate cancer, physical therapy will occur while you are going through the treatment process, although the frequency will be determined based on your radiation schedule.

Physical therapy is also recommended for prostate cancer patients who undergo hormone therapy or chemotherapy as part of their treatment.

Embarrassing, but a natural part of the process

Perhaps the biggest obstacle for prostate cancer survivors in seeking physical therapy is the mental one: Dealing with urinary leaks or urgency in urinary or bowel movements can quite literally turn survivors’ lives into accidents waiting to happen.

It’s much safer to stay at home than risk venturing into public and potentially embarrassing yourself or your family. Even going into a center for physical therapy could lead to an unfortunate incident while performing routine exercises.

An uncomfortable moment, though, is worth it if means equipping yourself with the techniques and routines that can improve your situation and, ultimately, your quality of life. Ask patients who have gone through cancer rehabilitation and pelvic health therapies and have come out on the other side, living life relatively normally again.

But that is also part of the problem, especially with prostate cancer patients.

Men are not known for sharing their private health concerns with each other. Urine leakage or sexual dysfunction isn’t usually the conversation at the bar or on the golf course. So, private successes men have after surgery and therapy may not be shared, eliminating one of the best vehicles for promoting health and wellness: word of mouth.

That may be gradually changing, especially as post-surgical therapy becomes more recognized. Patients who dealt with radiation decades ago and have been living with worsening leakage over time are seemingly seeking out physical therapy benefits more now, decades after prostate cancer treatment.

And, ultimately, they are experiencing an uptick in quality of life.

It doesn’t have to take so long. Be proactive after diagnosis and treatment and contact one of our cancer rehabilitation or pelvic health therapists as soon as possible.

Clinical contribution to this blog provided by Senior ReVital Cancer Rehabilitation Program Director Rhonda Ortuno and CoreVia Pelvic Health Physical Therapist and Cleveland Market Director Lauren Mercurio.