Urinary and sexual function do not mediate psychological distress reduction in the PC-PEP randomized controlled trial A secondary mediation analysis.

IF 2 4区医学 Q3 UROLOGY & NEPHROLOGY

Cuaj-Canadian Urological Association Journal Pub Date : 2026-10-01 DOI:10.5489/cuaj.9558

Budoor Salman, Nathan K Smith, Gabriela Ilie, Ross Mason, Ricardo A Rendon, Andrea Kokorovic, Cody MacDonald, Nikhilesh Patil, David Bowes, Greg Bailly, Derek Wilke, Eva Abou-Samra, Robert Rutledge

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引用次数: 0

Abstract

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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在PC-PEP随机对照试验中，泌尿和性功能不能调节心理困扰的减少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cuaj-Canadian Urological Association Journal 医学-泌尿学与肾脏学

CiteScore

2.80

自引率

10.50%

发文量

167

审稿时长

>12 weeks

期刊介绍： CUAJ is a a peer-reviewed, open-access journal devoted to promoting the highest standard of urological patient care through the publication of timely, relevant, evidence-based research and advocacy information.