Weight gain during prostate cancer treatment can worsen treatment-related side effects, impair quality of life, and increase risks of recurrence and prostate cancer–specific mortality. The Prostate Cancer Patient Empowerment Program (PC-PEP), a comprehensive, home-based 6-month digital intervention, has demonstrated improvements in diet, physical activity, and weight. This secondary analysis examined whether changes in diet and physical activity mediated weight loss among participants receiving PC-PEP. In a randomized clinical trial, 128 men with localized prostate cancer were assigned to PC-PEP (n=66) or standard care (n=62) for six months. Diet quality was assessed using a 12-item summary score reflecting weekly frequency of key food groups. Physical activity level was self-reported as not very active, moderately active, or very active. Mediation models were adjusted for age, comorbidity, treatment modality, time from randomization to treatment, relationship status, medication for anxiety or depression, and baseline weight, diet, and physical activity. The results show that weight loss in the PC-PEP group was significantly mediated by both diet and physical activity, accounting for 21% and 16% of the total effect, respectively. The direct effect of the intervention remained significant. These results indicate that improvements in diet and physical activity partially mediated weight loss in men receiving PC-PEP, while a substantial direct effect suggests that additional components of the intervention contribute to outcomes. Findings highlight the value of comprehensive, multi-faceted digital survivorship interventions for men with prostate cancer and suggest that observed mediation effects are conservative estimates given the use of brief self-reported behavioral measures.

Purpose: Prostate cancer survivors frequently lack access to comprehensive survivorship care, particularly in rural settings. We evaluated whether a digitally delivered, multicomponent survivorship program demonstrated equitable implementation and comparable longitudinal psychosocial outcomes across rural and urban contexts in an international Phase 4 implementation trial. Materials and Methods: This ongoing Phase 4, single-arm, prospective international implementation study evaluated the Prostate Cancer Patient Empowerment Program (PC-PEP), a 6-month, home-based digital intervention. Participants with prostate cancer completed assessments at baseline and 6, 12, and 24 months. Rural vs urban participants were compared on demographics, follow-up, and evaluation metrics. Exploratory longitudinal generalized estimating equation (GEE) models assessed change in psychological distress (K10) and health-related quality of life (SF-12 Mental Component Summary [MCS]), adjusting for covariates, and tested for differential trajectories by rurality. Results: Among 689 participants (urban n = 483; rural n = 206), follow-up completion was similar between groups at 6 months (82.1% vs 77.5%), 12 months (66.5% vs 68.5%), and 24 months (59.9% vs 56.6%). Baseline psychosocial, functional, and symptom outcomes were comparable. Program acceptability was high with ≥ 92% of participants recommending PC-PEP and endorsing that it should be standard care. Rural participants rated pelvic floor muscle training and dietary guidance more favorably. Psychological distress decreased and SF-12 MCS improved over time, with no difference by rurality. Conclusions: PC-PEP demonstrated equitable reach, follow-up, and perceived usefulness across rural and urban settings, alongside sustained improvements in mental health outcomes. These findings support scalable, equity-oriented digital survivorship care for men with prostate cancer.

INTRODUCTION:Men treated curatively for localized prostate cancer often experience urinary complications that impair quality of life. The Prostate Cancer-Patient Empowerment Program (PC-PEP) is a six-month, digital intervention integrating pelvic floor muscle training (PFMT), fitness, nutrition, and intimacy support. While early initiation of PC-PEP improves urinary outcomes, the influence of adherence remains unclear. This mediation analysis examined whether reported PFMT duration and engagement with self-monitoring mediate the association between timing of PC-PEP delivery (early vs. late) and urinary outcomes. METHODS:In a randomized, crossover trial, 128 men with localized prostate cancer were assigned to receive PC-PEP immediately (early group, n=66) or after six months of standard care (late group, n=62). Urinary outcomes were assessed using the Expanded Prostate Cancer Index Composite (EPIC) and International Prostate Symptom Score (IPSS). Weekly compliance surveys tracked engagement. Mediation and moderated mediation analyses adjusted for age, comorbidity, treatment modality, and baseline urinary function. RESULTS:Mean reported weekly PFMT duration did not differ between groups. The early group had higher compliance survey completion (98.8% vs. 64.1%, p<0.001) and higher post-intervention EPIC urinary incontinence scores (81.5±21.9 vs. 68.2±17.0, p<0.001), indicating better continence. Compliance survey completion mediated 41% of the association between early intervention and post-intervention EPIC urinary incontinence scores. No significant mediation was observed for IPSS or EPIC irritative/obstructive scores. Treatment modality did not moderate effects. CONCLUSIONS:Early initiation of PC-PEP was associated with greater engagement in structured self-monitoring, which mediated improvements in urinary continence independent of reported PFMT duration. Integrating early patient activation and digital self-monitoring into post-treatment care may improve urinary continence outcomes and support scalable rehabilitation.

Introduction: Black men experience persistent disparities across the prostate cancer continuum, including inequities in access to survivorship support. This study examined the perceived value, acceptability, and experiences of accessing a multicomponent digital survivorship program among Black men with prostate cancer. Methods: This exploratory mixed-methods study was embedded within the ongoing international Phase 4 implementation trial of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month digital intervention integrating exercise, pelvic floor muscle training, nutrition, stress management, psychosocial support, and peer connection. Fourteen self-identified Black participants contributed six-month program evaluation and qualitative data collected through open-ended responses and conference-based focus group discussions. Nine participants (64%) had undergone surgery with or without radiation and/or hormone therapy, four (29%) had received radiation with or without hormone therapy, and one (7%) was on active surveillance or had received no treatment. Quantitative data were summarized descriptively, and qualitative data were analyzed using inductive thematic analysis. Results: PC-PEP was highly valued, with median ratings of 10 (IQR 8–10) for likelihood of recommending the program and 9 (IQR 8–10) for overall usefulness. Among participants with available item-level data, 11/13 (85%) reported lifestyle improvement and 12/13 (92%) endorsed offering PC-PEP as standard care. Qualitative findings identified the value of holistic survivorship support, peer connection, normalization of vulnerability, and support for physical and psychological self-management. Participants also described limited awareness of PC-PEP at diagnosis and reliance on individual clinicians or incidental opportunities to learn about the program. Participants emphasized the need for earlier referral, greater representation, and culturally relevant community outreach. Conclusions: Black men who accessed PC-PEP reported high perceived value and identified benefits across multiple dimensions of survivorship. Their experiences, however, highlighted an important distinction between program availability and meaningful access: participants’ experiences suggest that availability alone may not ensure timely connection to survivorship support. Earlier referral, culturally responsive outreach, and integration of survivorship support into routine prostate cancer care may help close this gap.

Introduction: Men treated curatively for localized prostate cancer often experience urinary compli-cations that impairs quality of life. The Prostate Cancer-Patient Empowerment Program (PC-PEP) is a six-month digital intervention integrating pelvic floor muscle training (PFMT), fitness, nutrition, and intimacy support. While early initiation of PC-PEP improves urinary outcomes, the influence of adherence remains unclear. This mediation analysis examined whether reported PFMT duration and engagement with self-monitoring mediate the association between timing of PC-PEP delivery (early vs. late) and urinary outcomes. Methods: In a randomized crossover trial, 128 men with localized prostate cancer were assigned to receive PC-PEP immediately (early group, n=66) or after six months of standard care (late group, n=62). Urinary outcomes were assessed using the Expanded Prostate Cancer Index Composite (EPIC) and International Prostate Symptom Score (IPSS). Weekly compliance surveys tracked en-gagement. Mediation and moderated mediation analyses adjusted for age, comorbidity, treatment modality, and baseline urinary function. Results: Mean reported weekly PFMT duration did not differ between groups. The early group had higher compliance survey completion (98.8% vs. 64.1%, p<0.001) and higher post-intervention EPIC urinary incontinence scores (81.5±21.9 vs. 68.2±17.0, p<0.001), indicating better continence. Com-pliance survey completion mediated 41% of the association between early intervention and post-intervention EPIC urinary incontinence scores. No significant mediation was observed for IPSS or EPIC irritative/obstructive scores. Treatment modality did not moderate effects. Conclusions: Early initiation of PC-PEP was associated with greater engagement in structured self-monitoring, which mediated improvements in urinary continence independent of reported PFMT duration. Integrating early patient activation and digital self-monitoring into post-treatment care may improve urinary continence outcomes and support scalable rehabilitation.

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.

INTRODUCTION:This study aimed to evaluate the cost-effectiveness of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month comprehensive intervention designed to enhance psychological well-being and reduce healthcare expenditures among prostate cancer patients. METHODS:In a crossover randomized clinical trial of 128 men aged 50-82 years scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 men received the PC-PEP intervention immediately, while 62 were randomized to a waitlist control arm and received standard care for six months before receiving PC-PEP. The intervention included daily activities targeting physical fitness, pelvic floor training, stress management, intimacy, social support, and dietary guidance. Cost-effectiveness was assessed from a healthcare payer perspective using billing data from Nova Scotia's Medical Services Insurance (MSI) and self-reported outcomes. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were calculated using bootstrapped samples. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10), while quality-adjusted life years (QALYs) were estimated from SF-6D utility scores. RESULTS:PC-PEP resulted in cost savings of $411.53 CAD per patient at six months, with a 30% reduction in clinically significant psychological distress and a QALY gain of 0.013. At 12 months, savings increased to $660.89 CAD per patient, preventing 31% of distress cases and yielding a QALY gain of 0.034. These outcomes demonstrate that PC-PEP is a dominant intervention, achieving both improved clinical outcomes and reduced healthcare expenditures. CONCLUSIONS:PC-PEP is a dominant, cost-effective strategy that significantly improves psychological well-being while lowering healthcare costs. Early implementation following prostate cancer diagnosis is strongly recommended to maximize both clinical and economic benefits.

Introduction: The aim of this study was to evaluate the cost-effectiveness of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month comprehensive intervention designed to enhance psychological well-being and reduce healthcare expenditures among prostate cancer patients. Methods: In a crossover randomized clinical trial of 128 men aged 50–82 years scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 men received the PC-PEP intervention immediately, while 62 were randomized to a waitlist-control arm and received standard care for six months before receiving PC-PEP. The intervention included daily activities targeting physical fitness, pelvic floor training, stress management, intimacy, social support, and dietary guidance. Cost-effectiveness was assessed from a healthcare payer perspective using billing data from Nova Scotia’s Medical Services Insurance (MSI) and self-reported outcomes. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were calculated using bootstrapped samples. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10), while quality-adjusted life years (QALYs) were estimated from SF-6D utility scores. Results: PC-PEP resulted in cost savings of $411.53 CAD per patient at six months, with a 30% reduction in clinically significant psychological distress and a QALY gain of 0.013. At 12 months, savings increased to $660.89 CAD per patient, preventing 31% of distress cases and yielding a QALY gain of 0.034. These outcomes demonstrate that PC-PEP is a dominant intervention, achieving both improved clinical outcomes and reduced healthcare expenditures. Conclusions: PC-PEP is a dominant, cost-effective strategy that significantly improves psychological well-being while lowering healthcare costs. Early implementation following prostate cancer diagnosis is strongly recommended to maximize both clinical and economic benefits.

INTRODUCTION:Men diagnosed with prostate cancer (PCa) experience substantial psychological distress. Despite this, the use of screening tools in this population is limited and understudied. This study evaluates the validity of the Kessler Psychological Distress Scale (K10) as a psychological distress screening tool in men undergoing curative PCa treatment. METHODS:Participants in a PCa psychological distress prevention program (n=128) were assessed at baseline, six months, and 12 months using the K10. Exploratory (EFA) and confirmatory factor analysis (CFA) examined the scale's factor structure. Receiver operating characteristic (ROC) analyses evaluated sensitivity, specificity, and predictive values for depression and anxiety. Logistic regression assessed the impact of cutoffs on clinical psychological distress. RESULTS:EFA identified a single-factor structure (factor loadings: 0.59-0.96, variance explained: 76%). CFA confirmed model-fit (CFI=0.905; SRMR=0.042). ROC analysis demonstrated excellent predictive ability (area under the curve [AUC] 0.98, 95% confidence interval [CI] 0.95-1.0 for depression; 0.92, 95% CI 0.86-0.98 for anxiety). Youden's index suggested K10 thresholds of ≥17.5 (depression) and ≥16.5 (anxiety), although these cutoffs lacked sensitivity. With standard K10≥20 cutoffs, significant differences were observed between intervention and control groups at six months (adjusted odds ratio [aOR] 3.59, 95% CI 1.12-11.51, p=0.031) and 12 months (aOR 4.41, 95% CI 1.35-4.41, p=0.014), consistent with prior findings. CONCLUSIONS:The K10 is valid and reliable for this population, demonstrating excellent internal consistency; however, lower cutoffs (K10≥16.5, K10≥17.5) may reduce sensitivity. The standard K10≥20 threshold remains preferable for detecting distress and evaluating intervention effects in men with PCa.

Introduction: Men diagnosed with prostate cancer (PCa) experience substantial psychological distress. Despite this, the use of screening tools in this population is limited and understudied. This study evaluates the validity of the Kessler Psychological Distress Scale (K10) as a psychological distress screening tool in men undergoing curative PCa treatment. Methods: Participants in a PCa psychological distress prevention program (n=128) were assessed at baseline, six months, and 12 months using the K10. Exploratory (EFA) and confirmatory factor analysis (CFA) examined the scale’s factor structure. Receiver operating characteristic (ROC) analyses evaluated sensitivity, specificity, and predictive values for depression and anxiety. Logistic regression assessed the impact of cutoffs on clinical psychological distress. Results: EFA identified a single-factor structure (factor loadings: 0.59–0.96, variance explained: 76%). CFA confirmed model-fit (CFI=0.905; SRMR=0.042). ROC analysis demonstrated excellent predictive ability (area under the curve [AUC] 0.98, 95% confidence interval [CI] 0.95–1.0 for depression; 0.92, 95% CI 0.86–0.98 for anxiety). Youden’s index suggested K10 thresholds of ≥17.5 (depression) and ≥16.5 (anxiety), although these cutoffs lacked sensitivity. With standard K10≥20 cutoffs, significant differences were observed between intervention and control groups at six months (adjusted odds ratio [aOR] 3.59, 95% CI 1.12–11.51, p=0.031) and 12 months (aOR 4.41, 95% CI 1.35–4.41, p=0.014), consistent with prior findings. Conclusions: The K10 is valid and reliable for this population, demonstrating excellent internal consistency; however, lower cutoffs (K10≥16.5, K10≥17.5) may reduce sensitivity. The standard K10≥20 threshold remains preferable for detecting distress and evaluating intervention effects in men with PCa.

Background: The Prostate Cancer—Patient Empowerment Program (PC-PEP) is a six-month daily home-based program shown to improve mental health and urinary function. This secondary analysis explores weight loss in male PC-PEP participants. Methods: In a randomized clinical trial with 128 men undergoing curative prostate cancer (PC) treatment, 66 received ‘early’ PC-PEP, while 62 were assigned to the ‘late’ waitlist-control group, receiving 6 months of standard-of-care treatment followed by 6 months of PC-PEP. PC-PEP comprised 182 daily emails with video-based exercise and dietary (predominantly plant-based) education, live online events, and 30 min strength training routines (using body weight and elastic bands). Weight and height data were collected via online surveys (baseline, 6 months, and 12 months) including medical chart reviews. Adherence was tracked weekly. Results: No attrition or adverse events were reported. At 6 months, the early PC-PEP group experienced significant weight loss, averaging 2.7 kg (p < 0.001) compared to the waitlist-control group. Weight loss was noted in the late intervention group of PC-PEP, albeit less pronounced than in the early group. Early PC-PEP surgery patients lost on average 1.4 kg (SE = 0.65) from the trial’s start to surgery day. High adherence to exercise and dietary recommendations was noted. Conclusions: PC-PEP led to significant weight loss in men undergoing curative prostate cancer treatment compared to standard-of-care.

Understanding how interventions reduce psychological distress in patients with prostate cancer is crucial for improving patient care. This study examined the roles of self-efficacy, illness perceptions, and heart rhythm coherence in mediating the effects of the Prostate Cancer Patient Empowerment Program (PC-PEP) on psychological distress compared to standard care. In a randomized controlled trial, 128 patients were assigned to either the PC-PEP intervention or standard care. The PC-PEP, a six-month program emphasizing daily healthy living habits, included relaxation and stress management, diet, exercise, pelvic floor muscle exercises, and strategies to improve relationships and intimacy, with daily activities supported by online resources and live sessions. Participants in the intervention group showed significant improvements in self-efficacy and specific illness perceptions, such as personal control and emotional response, compared to the control group. These factors mediated the relationship between the intervention and its psychological benefits, with self-efficacy accounting for 52% of the reduction in psychological distress. No significant differences in heart rhythm coherence were observed. This study highlights the critical role of self-efficacy and illness perceptions in enhancing psychological health in prostate cancer patients through the PC-PEP. The results underscore this program’s effectiveness and the key mechanisms through which it operates. Given the high rates of distress among men undergoing prostate cancer treatments, these findings emphasize the importance of integrating the PC-PEP into clinical practice. The implementation of the PC-PEP in clinical settings can provide a structured approach to reducing psychological distress and improving overall patient well-being.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (PD61)1 May 2024PD61-07 THE COMPREHENSIVE 6-MONTH PROSTATE CANCER-PATIENT EMPOWERMENT PROGRAM (PC-PEP) IMPROVES URINARY FUNCTION AMONG MEN WITH PROSTATE CANCER: PRELIMINARY RESULTS OF a PHASE 4 PAN-CANADIAN AND INTERNATIONAL IMPLEMENTATION TRIAL Charlie Gillis, Gabriela Ilie, Cody MacDonald, Ross Mason, Ricardo Rendon, Nikhilesh Patel, David Bowes, Greg Bailly, David Bell, Derek Wilke, and Robert Rutledge Charlie GillisCharlie Gillis , Gabriela IlieGabriela Ilie , Cody MacDonaldCody MacDonald , Ross MasonRoss Mason , Ricardo RendonRicardo Rendon , Nikhilesh PatelNikhilesh Patel , David BowesDavid Bowes , Greg BaillyGreg Bailly , David BellDavid Bell , Derek WilkeDerek Wilke , and Robert RutledgeRobert Rutledge View All Author Informationhttps://doi.org/10.1097/01.JU.0001009352.31737.3d.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Prostate Cancer-Patient Empowerment Program was found to be effective in improving urinary symptoms for patients undergoing primary treatment for localized prostate cancer. This implementation trial seeks to determine the effects of the PC-PEP intervention in patients who are at various stages in their prostate cancer management. METHODS: 186 men with a variety of treatments for localized and metastatic prostate cancer were enrolled in PC-PEP, an online, comprehensive patient resource comprising physical, mental, and social support. Daily emails or texts reminded men to follow the program's PFMT videos 3 times per day. Videos included relaxation, quick-twitch and endurance exercises. Patients then completed weekly online compliance surveys and the International Prostate Symptom Score (IPSS) questionnaire at baseline and six months. RESULTS: Demographic characteristics are presented in Table 1. On average, the PC-PEP group reported performing PFMT 3.5 times per day (3 times a day was prescribed). Overall, men who received the PC-PEP intervention had significantly improved IPSS sum score when compared to baseline (mean IPSS difference 1.56 (95% CI 0.52–2.60, p=0.003). Urinary function was better than baseline among the 107 patients who had received radical prostatectomy (mean IPSS difference 1.94 (95% CI 0.40–3.50, p=0.014), and the 73 patients who were treated with radiation (either beam or brachy), mean IPSS difference 1.7 (95% CI 0.31–3.09, p=0.017. Men on active surveillance or hormone therapy only, showed comparable urinary function from pre- to post-intervention (p=0.19 and p=0.11, respectively). Patients who received salvage radiation had improved urinary function, mean IPSS difference 4.46 (95% CI 1.80–7.13, p<0.002). CONCLUSIONS: PC-PEP appears to significantly improve urinary tract symptoms in prostate cancer patients who are in various stages of disease treatment. Patients who underwent salvage radiotherapy may derive the most benefit. These findings add to our previous RCT results showing that PC-PEP significantly improves urinary function among men with curative disease. Source of Funding: Dalhousie Medical Research Foundation © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1282 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Charlie Gillis More articles by this author Gabriela Ilie More articles by this author Cody MacDonald More articles by this author Ross Mason More articles by this author Ricardo Rendon More articles by this author Nikhilesh Patel More articles by this author David Bowes More articles by this author Greg Bailly More articles by this author David Bell More articles by this author Derek Wilke More articles by this author Robert Rutledge More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: This is a secondary analysis examining a six-month home-based Prostate Cancer-Patient Empowerment Program (PC-PEP) on patient-reported urinary, bowel, sexual, and hormonal function in men with curative prostate cancer (PC) against standard of care. Methods: In a crossover clinical trial, 128 men scheduled for PC surgery (n = 62) or radiotherapy with/without hormones (n = 66) were randomized to PC-PEP (n = 66) or waitlist-control and received the standard of care for 6 months, and then PC-PEP to the end of the year. PC-PEP included daily emails with video instructions, aerobic and strength training, dietary guidance, stress management, and social support, with an initial PFMT nurse consultation. Over 6 months, participants in the PC-PEP received optional text alerts (up to three times daily) reminding them to follow the PFMT video program, encompassing relaxation, quick-twitch, and endurance exercises; compliance was assessed weekly. Participants completed baseline, 6, and 12-month International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC) questionnaires. Results: At 6 months, men in the PC-PEP reported improved urinary bother (IPSS, p = 0.004), continence (EPIC, p < 0.001), and irritation/obstruction function (p = 0.008) compared to controls, with sustained urinary continence benefits at 12 months (p = 0.002). Surgery patients in the waitlist-control group had 3.5 (95% CI: 1.2, 10, p = 0.024) times and 2.3 (95% CI: 0.82, 6.7, p = 0.11) times higher odds of moderate to severe urinary problems compared to PC-PEP at 6 and 12 months, respectively. Conclusions: PC-PEP significantly improves lower urinary tract symptoms, affirming its suitability for clinical integration alongside established mental health benefits in men with curative prostate cancer.

Introduction: A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examines trends in surgeon compensation for these treatments within Canada. Methods: The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examining first, the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35–44. Results: Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35–44. Conclusions: The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.

Background/Objectives: The Prostate Cancer Patient Empowerment Program (PC-PEP) is a 6-month, home-based intervention aimed at enhancing mental health in men undergoing curative prostate cancer treatment. This exploratory secondary analysis evaluates PC-PEP’s impact on relationship satisfaction, quality of life, and support group attendance among partnered participants. Methods: In a crossover randomized clinical trial ClinicalTrials.gov identifier: NCT03660085) of 128 men aged 50–82 scheduled for curative prostate cancer surgery or radiotherapy, 119 participants in relationships were included. Of these, 59 received the 6-month PC-PEP intervention, while 60 were randomized to a waitlist-control arm, receiving standard care for 6 months before starting PC-PEP. The intervention included daily emails with video instructions on mental and physical health, diet, social support, fitness, stress reduction, and intimacy. Outcomes were assessed using the Dyadic Adjustment Scale (DAS) and the Functional Assessment of Cancer Therapy–Prostate (FACT-P). Results: While relationship satisfaction remained stable, a significant improvement in emotional well-being was observed at 12 months in participants undergoing radiation therapy (p = 0.045). The PC-PEP intervention also led to significantly higher support group attendance at both 6 months (p = 0.001) and 12 months (p = 0.003), emphasizing its role in fostering social support and community engagement. Conclusions: The PC-PEP program effectively maintains relationship satisfaction and enhances emotional well-being, particularly in patients with fewer physical side effects. Its design promotes comprehensive care by integrating physical, psychological, and social support, making it a valuable resource for improving the quality of life in prostate cancer patients and potentially applicable to other cancer types.

INTRODUCTION: A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examined trends in surgeon compensation for these treatments within Canada. METHODS: The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examined first the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35-44. RESULTS: Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35-44. CONCLUSIONS: The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.