Part 3: Shopping for Urologists and Surgeons: Navigating Multiple Doctor Visits and Prostate Cancer Opinions

Part 3 of the Series: Living With, Deciding On, and Surviving Prostate Cancer

NOTE: If you want to read earlier parts of this series, refer to these links:
Part 1 • Part 2

Once you close the Reddit tabs and hang up with the guys from the whisper network, a jarring reality hits you square in the chest: you actually have to walk into medical offices and let people poke, prod, and pitch you on how they plan to alter your body.

In the prostate cancer universe, you quickly learn the golden rule of oncology: what you choose often depends on who you ask.

If you visit a high-volume robotic surgeon, they will show you pristine 3D models of the DaVinci surgical console and explain why cutting the organ out clean is the only way to sleep peacefully at night. If you visit a radiation oncologist, they will sing the praises of image-guided photon beams, proton centers, or CyberKnife stereotactic radiosurgery, assuring you that the knife is barbaric and modern precision targeting spares surrounding tissue. And if you seek out an interventional radiologist or an academic innovator specializing in focal therapies, they will talk to you about targeted destruction—zapping or freezing just the tumor while preserving the rest of the organ like a lumpectomy.

Everyone has data. Everyone has charts. And everyone has their own surgical or clinical hammer, which means your prostate looks remarkably like their preferred nail.

Living in New York City meant I had access to some of the top-ranked cancer centers and academic medical institutions in the world. On paper, this is an immense privilege. In practice, it meant subjecting myself to an exhausting, high-stakes gauntlet of doctor shopping across Manhattan and beyond.

My notebook in hand, I scheduled appointments across major academic hospital systems. I wasn’t just there to review pathology slides, Gleason scores, and multiparametric MRI scans. I was there to conduct an interview.

Before anyone was going to touch my pelvic anatomy, they had to pass a very specific test: Could they look me in the eye and talk frankly about gay sex?

You find out very quickly who is up for that conversation and who isn’t.

At one prestigious cancer center, I sat across from a renowned surgical oncologist whose walls were lined with degrees, fellowships, and framed society awards. He was polished, authoritative, and moved through my scans with practiced ease. He laid out a classic bilateral nerve-sparing robotic prostatectomy.

Then I asked the questions that mattered most to my actual life:

“I’m a sexually active gay man. What does this procedure do to my sensation during receptive anal sex? What happens to the pelvic floor muscles when the prostate and seminal vesicles are removed? How does that impact anejaculatory orgasms or the physical feeling of fullness during bottoming?”

The shift in the room was palpable.

His eyes flickered down to his chart. He cleared his throat. He leaned back in his chair and offered a textbook, diplomatic non-answer: “Well, our primary goal is oncologic control—eradicating the cancer. After twelve to twenty-four months of recovery, most patients can achieve an erection suitable for intercourse with a partner using PDE5 inhibitors like Viagra, or penile injections if necessary. Intimacy can certainly resume.”

He didn’t say the word “gay.” He didn’t address the rectum. He didn’t acknowledge receptive intercourse, the pelvic nerve hammock, or orgasmic intensity. To him, “sexual function” was a binary box: could a penis become rigid enough to insert somewhere?

That was an immediate disqualifier.

If a doctor cannot even speak your anatomical truth out loud without clinical discomfort, they sure as hell aren’t thinking about preserving your specific nerve pathways or pelvic elasticity when they’re operating on you.

At another consultation, I sat with a radiation team. They were warmer, but the blind spots remained. When I asked about late-onset radiation proctitis—the chronic rectal inflammation, vascular fragility, and potential scar tissue that can develop years after radiation beams hit the pelvic floor—the response was casual: “Modern beam shaping minimizes rectal dose. It’s rare to see severe bleeding.”

Rare for a straight man whose rectal wall never encounters physical friction again, perhaps. But for a gay man who enjoys anal intimacy? Even low-grade chronic radiation proctitis or mucosal friability can permanently shut the door on receptive sex.

I left that office feeling more isolated than when I walked in. I was tired of being treated like a generic pelvic cross-section. I wanted a clinician who looked at my pathology with rigorous oncological standards, but who also respected my quality of life, my identity, and the modern science of targeted organ preservation.

I needed someone who wasn’t threatened by a patient who came armed with clinical study abstracts. Someone who didn’t dismiss focal ablation as an experimental compromise, but understood it as a sophisticated, precision-engineered strategy for the right candidate.

And then, several consultations and dozens of medical records later, I walked into an office that shifted the entire trajectory of my diagnosis.

TO BE CONTINUED…

Featured image by Mike B. | Bottom Basics

Wednesday October 7, 2026