Pearls & Perspectives: Optimizing Outcomes in Prostate Cancer, with Mark L. Gonzalgo, MD, PhD

In this special Prostate Cancer Awareness Month episode of Pearls and Perspectives, host Amy Pearlman, MD, welcomes Mark Gonzalgo, MD, PhD, chair of the Desai Sethi Urology Institute and a nationally recognized expert in prostate cancer surgery. Their discussion highlights innovations in surgical technique, the importance of patient-centered decision-making, and how multidisciplinary care can optimize outcomes.Gonzalgo explains the Retzius-sparing robotic radical prostatectomy, a technique that avoids disturbing critical tissues controlling urination and can accelerate recovery of continence and sexual function in appropriately selected patients. He shares insights on ideal candidates, surgical learning curves, and the balance between cancer control and functional preservation. Real-world examples, including a shared patient who recovered sexual function remarkably quickly, underscore the impact of surgical nuance combined with prehabilitation strategies such as pelvic floor training.The conversation also tackles testosterone therapy in men with prostate cancer, a complex and sometimes controversial issue. Gonzalgo emphasizes individualized decisions, noting that for men with lower- to intermediate-risk disease, continuing therapy may be reasonable. Both physicians stress the value of keeping patients anabolic and active before surgery to support postoperative recovery.Looking ahead, Gonzalgo outlines how artificial intelligence, advanced imaging, and genomic classifiers are shaping the future of prostate cancer care by enabling more precise personalization of treatment. He offers guidance for colleagues on optimizing patient communication, reminding early-career urologists to “never lose sight of the person behind the cancer.” His closing message to patients: Take time, gather information, and know you are not alone in your decision-making.This episode provides practicing urologists with practical insights into evolving surgical techniques, multidisciplinary collaboration, and strategies to enhance both oncologic and quality-of-life outcomes in prostate cancer care.Chapters2:14 Discussing a shared patient6:23 The ideal candidate for Retzius-sparing prostatectomy8:33 Testosterone and prostatectomy13:27 Can prostatectomy be improved?14:58 The role of AI15:40 What excites Dr Gonzalgo in the prostate cancer space