Urinary and sexual function do not mediate psychological distress reduction in the PC-PEP randomized controlled trial
A secondary mediation analysis
DOI:
https://doi.org/10.5489/cuaj.9558Keywords:
prostate cancer, psychological distress, survivorship, patient empowerment, urinary function, sexual function, patient-reported outcomesAbstract
Introduction: Psychological distress is common among men treated for localized prostate cancer and is often presumed to stem from treatment-related urinary and sexual sequelae. The Prostate Cancer-Patient Empowerment Program (PC-PEP), a six-month, comprehensive, digital intervention, reduces psychological distress and improves patient-reported urinary and sexual function. This secondary analysis tested whether improvements in urinary incontinence, urinary irritative/obstructive symptoms, or sexual function explain PC-PEP’s effect on psychological distress.
Methods: In a randomized controlled trial, 128 men with localized prostate cancer were assigned to PC-PEP (n=66) or standard care (n=62) for six months. Psychological distress was measured using the Kessler psychological distress scale (K10), and urinary and sexual function were assessed using the expanded prostate cancer index composite (EPIC) at baseline and six months. Mediation models adjusted for age, relationship status, use of medications for anxiety or depression, Charlson comorbidity index, treatment modality, time from randomization to treatment, and baseline K10 and EPIC scores.
Results: PC-PEP produced significant improvements in urinary incontinence and urinary irritative/obstructive symptoms across the full cohort and attenuated postoperative declines in sexual function; however, none of these urinary or sexual outcomes mediated the program’s effect on psychological distress.
Conclusions: While PC-PEP enhances key urinary and postoperative sexual outcomes, these functional gains do not account for its mental health benefits. This challenges the assumption that psychological distress in prostate cancer survivorship is predominantly driven by urinary or sexual sequelae and highlights the importance of addressing broader psychosocial and behavioral determinants of mental health in survivorship care.
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Author Biographies
Budoor Salman, Department of Urology, Faculty of Medicine, Dalhousie University
Nathan K. Smith, Department of Community Health and Epidemiology
Post Doctoral Fellow, Epidemiology
Gabriela Ilie, Dalhousie University
Chair in Prostate Cancer Survivorship Research. Dr. Ilie’s substantive interests are in the areas of prostate cancer health related quality of life, survivorship, patient education and patient empowerment programs, patient-reported outcomes, population health, mental health, substance use, and health policy. She is particularly interested in the intersection of chronic illness and various patient-reported disease-specific and health related quality of life outcomes, with a special emphasis on adults and aging.
Ross Mason, Department of Urology, Faculty of Medicine, Dalhousie University
Associate Professor, Urologist
Ricardo A. Rendon, Department of Urology, Faculty of Medicine, Dalhousie University
Professor, Urologist
Andrea Kokorovic, Department of Urology, Faculty of Medicine, Dalhousie University
Associate Professor, Urologist
Cody MacDonald, Department of Community Health and Epidemiology
International Project Manager
Nikhilesh Patil, Department of Radiation Oncology
Associate Professor, Radiation Oncologist
David Bowes, Department of Radiation Oncology
Professor, Radiation Oncologist
Greg Bailly, Department of Urology, Faculty of Medicine, Dalhousie University
Professor, Urology Head, Urologist
Derek Wilke, Department of Radiation Oncology, Faculty of Medicine, Dalhousie University
Professor, Radiation Oncologist
Eva Abou-Samra, Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University
MSc Student, Epidemiology
Robert Rutledge, Department of Radiation Oncology, Faculty of Medicine, Dalhousie University
Associate Professor, Radiation Oncologist
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