50 and Full of Life. Need advice. TULSA or HIFU or what?

I had my single port RARP performed on Thursday, April 9th, 2026.
When I woke up, my voice sounded like I'd been inhaling helium and my chest felt like I had a heavy weight on it. They told me this was typical, and released me, so my wife drove me home that evening.
I went home and slept through the night, but when I woke on Friday, I had large pockets of air bubbles under my skin in my chest and neck, my voice was still high, my chest was still heavy, and I could only take shallow breaths. I called my urologist / surgeon and was told to go to the ER.
x-rays and CT scan showed that my left lung had collapsed. (The forced air intubation during surgery popped my left lung like a balloon, and the way my entire chest felt, I believe came close to popping my right lung too.)
A lung tube was inserted and I spent 3 days in the ER and hospital. (Freak occurrence, but it can happen to anybody I guess.)

Catheter was removed on Friday, April 17th.
I had almost 100% continence immediately. I wore one pullup, but didn't need it, so I switched to pads. I only dribble a drop or two when I'm up and down from a squatted floor position. I don't leak in my sleep at all. So, I use 1 or less pads per day, if I chose to reuse them from day to day. THIS IS GOOD NEWS!!!

My surgeon told me that my nerve bundles were preserved. THIS IS ALSO GOOD NEWS!!!

My surgeon also went over my pathology report with me. It 'indicates' that 100% of the cancer was contained within the prostate and that my margines were clear. My follow up PSA tests will tell more, but THIS IS GOOD NEWS TOO!!!

The ONLY item in my pathology report that catches my uneducated eye is this:
"MARGINS STATUS: Focally positive, right apex."
Google states:
"a small, limited number of cancer cells were found at the very edge of the tissue specimen that was removed."

This is concerning to me, but I'm trusting what my surgeon told me and I'm not going to lose any sleep over it. I will cross that bridge if my PSA levels ever start creeping up again.

I thankful to God and all of the prayers I received, and my surgical team! With the collapsed lung issue behind me, I'd say my overall healing process is progressing very well for only being like 1.5 weeks post surgery. The 10 pound lifting restriction is impossible for me to follow, so I'm just listening to my body and am limiting my internal strain and pressure, in order to stave off developing a hernia. Initially, coughing and sneezing felt like they were going to split me open, (and made me pee a few drops), but they aren't too bad now, especially if I can brace myself for them.

I have no doubt that I'll be back on a bike saddle soon, but won't attempt it until my surgeon gives me the green light. (Targeting 6 to 12 weeks, post surgery.) I'd like to jump on my wife today, but that's on pause for the moment too. I have faith full functionality will come back, and am eager to get started on penial rehab, but my surgeon won't green light me for that for a few weeks yet.

I am SO THANKFUL IT IS OVER!!! I researched this WAY TOO MUCH, went down too many rabbit holes, and read too many horror stories, prior to surgery. I was not in a good place and have never experienced so much anxiety in my life, pre surgery.

@cxracer
Happy to hear that you are doing well now. Things happen regardless. I had a blood clot in my right calf a week after surgery although looking back I had symptoms several days earlier. Same thing off to ER. I get infused with IVIG twice a year due to being immunocompromised with very low igg immune levels. This was all from my cancer treatments 20 years ago. awhile. They think that could have contributed. Everything is about statistics. I don’t know anyone who believes any procedure’s side effects won’t happen or guarantees of success. Their are people that these things happen to if some number is even 3% for side effects because it is a statistic number from occurrence’s. You just don’t want to be in that 3%. Likewise statistics for drop in side effects are that too. Higher improved statistics from studies showing improvement one way over another is just as important

(Last week) 3.5 weeks post RARP I was feeling good, so I began using my vertical climber and processed some firewood. Controlled breathing techniques keep me from creating too much internal pressure, so I don't cause a hernia, or so I thought. No hernia, but I developed excruciating bi-lateral sciatica. Walking was fine, but sitting or lying down made me want to crawl out of my skin. NSAIDs have helped to decrease the inflammation, and the sciatic pain along with it. Thank God! I'll be slowing my roll from here on out and realize that the recovery timeline I have planned out in my head is unrealistically optimistic. This pushes my first biking attempt way out.

Incontenence continues to improve. I dribble occasionally, especially when I'm down and up, or down and shift or twist to one side. It's worse in the evening, as I'm guessing my pelvic floor muscles are tired from the day. I believe I'm a bit ahead of the curve with incontinence recovery and have little concern that I won't fully recover over time.

I started 5mg daily of generic Cialis last week and have been preforming penile rehab for the past 2 weeks. I get sensations like I should be erect, or getting erect, but it's just an illusion. I've attempted to take things for a test drive, and no-go. My wife and I were intimate for the first time yesterday, and no-go. So, that's disappointing and frustrating. I pray to God that this comes back!

Being sedentary was much easier when I was tender and feeling crummy. It's extremely difficult now that I'm feeling mostly normal now. I want so desperately to get back to enjoying life. I know, I'm only a month out, and I'm being a baby. Patience is not one of my strong suits and is one of the things that I've prayed for. Well, be careful with that, because sometimes God gives you exactly what you pray for.

@cxracer
You found the reason they tell you wait six weeks before doing anything strenuous following stomach surgery. I wanted to go to the gym so bad after a surgery last year, But realize that the minor discomfort I felt down there was telling me it was still healing. At six weeks, I no longer felt that.

There’s nothing wrong with walking. You could take long walks and get some of that energy out.

I had a very similar diagnosis in very similar circumstances. Young wife, active life. My consultant recommended surgery within 6 weeks. I disagreed, did my own research and put myself on active surveillance. Nearly 4 years in now, no progression so far. Not saying I won’t need treatment at some point but I’ve already had almost 4 great years of full function I would have lost.

My experience even led to me writing a book about called Manhandled and setting up a free resource for men on active surveillance that categorises all the interventions based on evidence. Happy to share more if helpful.

Paul

@paulsweeney Well, obviously it's of no help to me at this point, since I went through with the surgery, but others may benefit.

Best wishes for a great recovery