Josh's Story*
Step 1
Josh discovered what mattered
Josh (he/him) is a 45-year-old computer programmer, competitive triathlete, husband, and father of two teenage boys who was referred by his urologist after being told he had aggressive prostate cancer, Gleason score 8, with surgery in just 15 days. His wife had recently been diagnosed with breast cancer, their 13-year-old son was struggling emotionally, and they'd just moved interstate without family support. Googling frantically, Josh was terrified about losing bladder control and his sexual function. When he came to see us, he was doing 100 pelvic floor exercises and 100 sit-ups daily but had no idea if he was doing them correctly. Through the Prostate Cancer Distress Screen, we identified significant anxiety about his diagnosis, surgery outcomes and family impact. His pelvic floor assessment showed excellent function, but he was overdoing exercises and creating fatigue, not strength.
Josh's Pelvic Health Goals:
- Ensure my pelvic floor muscles are optimally prepared and understand what to expect after surgery so I can plan.
- Minimise bladder leakage after surgery so I can socialise without worrying.
- Get back to work quickly - my team is counting on me.
- Return to triathlons - they keep me sane.
- Regain sexual function - intimacy with my wife is important.
- Feel like myself again - not like a cancer patient.
Step 2
Josh restored what mattered
We provided education about surgery and realistic recovery timelines. Using ultrasound feedback, we corrected his pelvic floor and sphincter technique and designed an exercise program focussing on quality over quantity. We addressed his fluid intake and used the Distress Screen score to discuss his psychological burden, providing stress management strategies including breathing exercises and mindfulness.
Post-Surgery (1 week): Surgery went well. He was dry at night but felt spurts when moving. We modified his program and ensured Josh was contracting before movements that might cause leakage.
Post-Surgery (3 months): Josh had returned to work and training but was experiencing leakage with running and weights and complete absence of erectile function. We progressed his program to support high-impact activities and provided education about erectile dysfunction recovery. We revisited the Distress Screen and addressed his fear of leaking.
Step 3
Josh enjoyed what mattered
After 8 months, Josh was completely dry and completed his first post-cancer triathlon with a personal best. His erectile function had begun returning, and he and his wife reconnected intimately being "a team again" as cancer survivors. Josh organised a workplace charity fun run wearing a shirt saying "Strong Together." Eighteen months post-surgery, Josh completed an Ironman triathlon with his wife and sons cheering, proving that prostate cancer doesn’t have to define or limit your life.