Prostate cancer is the most common internal malignancy in men, with a lifetime prevalence of 1 in 6 men. The most common treatment is radical prostatectomy. A national patient survey indicated that 31% of men were still using absorbent pads 1 year after prostatectomy. Four randomized, controlled trials have demonstrated the effectiveness of a clinic-based perioperative rehabilitation program to reduce post- prostatectomy incontinence, including one by the investigators. Given the high prevalence of prostate cancer at the VA and the impact incontinence has on quality of life, rehabilitation should be offered to all veterans undergoing radical prostatectomy. However, few VA medical centers possess this expertise. The purpose of the proposed study is to adapt this successful, evidence-based, perioperative rehabilitation program for administration via telehealth technology. The first 6 months of this developmental study will be needed to adapt the perioperative rehabilitation protocol (pelvic floor muscle training, progressive exercises, and bladder control techniques) for telehealth administration. Currently in wide use throughout the VA, telehealth technology will allow guidance through the rehabilitation program, and should improve adherence through regular monitoring and proactive problem solving. Outcome measures will be obtained via telehealth and include the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF), the 4-item Urinary Incontinence Subscale of the Expanded Prostate Cancer Index (EPIC), and the single-item Estimated Percent Improvement (EPI), Global Perception of Improvement (GPI), and Patient Satisfaction Question (PSQ). The final 18 months of the developmental study will be used to pilot test the 6-month program with veterans undergoing radical prostatectomy. At the completion of the rehabilitation program, each participating veteran will evaluate the program, both individually and in focus groups. The primary outcome for this developmental study is feasibility. The program will be considered feasible if: (1) 75% of eligible veterans undergoing radical prostatectomy at the Birmingham VA Medical Center who meet inclusion criteria agree to participate in the program, and (2) 75% of enrolled veterans successfully complete the study, defined as completing the ICIQ-SF at least monthly and providing 6-month data. The proposed developmental study is the next step in a research program with the potential to alter standards of care with a cost-effective, state-of-the-art, rehabilitation program for veterans undergoing radical prostatectomy. A Merit Review application will then follow to conduct a randomized controlled trial of the intervention. If the telehealth-administered program proves successful for reducing time to continence and severity of postprostatectomy incontinence, it could then be widely disseminated to improve the care and quality of life for the many veterans undergoing surgery for prostate cancer each year.
Prostate cancer is the most common internal malignancy in men with a lifetime prevalence of 1 in 6 men. Patient surveys indicate that significant incontinence persists in approximately one third or men more than a year after surgery. Involuntary loss of urine is often a physical, emotional, psychosocial and economic burden for these men. The proposed study is to develop and pilot test an evidence-based, telehealth-administered rehabilitation program which, if effective, could be widel implemented, improve incontinence outcomes for veterans undergoing prostatectomy, and have profound cost saving implications for the VA health system.