Rehabilitation and Sex Therapy to Optimize Recovery After Prostate Cancer Treatment

Accrual rate will be used to assess feasibility of recruiting participants to the study target of 30 participants. This feasibility trial is designed to estimate key process parameters with precision rather than to test efficacy hypotheses

Consent rate will be used to assess enrollment feasibility. This measure reflects the proportion of eligible participants who provide informed consent after screening and outreach.

Randomization rate will be used to assess the proportion of consented eligible participants who are randomized in a 1:1 ratio to pelvic floor physical therapy (PFPT) plus sex therapy or PFPT alone.

Retention will be used to assess the proportion of randomized participants who remain in the study through the 12-month follow-up timepoint.

Assessment completion will be used to assess feasibility of longitudinal data collection across the planned study schedule. Scheduled patient-reported outcome assessments occur at baseline and during follow-up contacts.

Intervention exposure metrics will be used to assess feasibility of delivering and receiving the rehabilitation pathway. This includes participation in PFPT.

Intervention exposure metrics will be used to assess feasibility of delivering and receiving the rehabilitation pathway. This includes sex therapy participation in the intervention arm.

Intervention exposure metrics will be used to assess feasibility of delivering and receiving the rehabilitation pathway. This includes recommended penile rehabilitation use patterns including vacuum erection device (VED) and PDE-5i use as measured via adherence logs.

Fidelity-monitoring feasibility will be assessed using audio recording of sex therapy sessions and audit of a planned 20% sample of recordings using fidelity checklists.

Participants assigned to sex therapy will complete the 13-item Satisfaction with Therapy and Therapist Scale-Revised specific to the sex therapy they are currently attending or have completed. The first 12 items assess agreement with statements related to therapy and therapist satisfaction on a 5-point scale from "strongly disagree" (1) to "strongly agree" (5). The 13th item asks how much the treatment helped with the specific problem that led the participant to therapy, with response options ranging from "made things a lot better" to "made things a lot worse."

Participants in both arms will complete the 13-item Satisfaction with Therapy and Therapist Scale-Revised specific to pelvic floor physical therapy. The first 12 items assess agreement with statements related to therapy and therapist satisfaction on a 5-point scale from "strongly disagree" (1) to "strongly agree" (5). The 13th item asks how much the treatment helped with the specific problem or concern that led the participant to therapy, with response options ranging from "made things a lot better" to "made things a lot worse."

The International Prostate Symptom Score with bother index/quality-of-life assessment is an 8-item measure that will be used to assess urinary symptoms and urinary-related bother. The first 7 questions assess symptom severity and scores may range from 1 to 35, where higher scores indicate higher symptom severity. The final question assesses urinary-related bother on a scale of 0 to 6, where a higher score indicates higher bother.

The International Index of Erectile Function-5 will be used to assess erectile function. At screening, if a pretreatment IIEF-5 is not available in the medical record, a screening IIEF-5 will be collected post-treatment with recall anchored to the month prior to treatment. Sum scores range from 5 to 25, where higher scores indicate higher erectile dysfunction.

The PROMIS Sexual Function and Satisfaction Measure male brief profile is an 8-item measure used to capture sexual function, sexual satisfaction, and reasons for no sexual activity without requiring partner status. Scores range from 5 to 40, where higher scores indicate higher sexual function and satisfaction.

PROMIS-16 Profile v2.1 (PROPr) is a 16-item measure used to assess general health status and utility. Scores range from 16 to 80, with higher scores indicating worse health status and utility.

PROMIS Global Health is a 10-item measure used to assess general health status and utility. The first 9 items are measured on a 5-point Likert scale, for sum scores of 9 to 45, where higher scores indicate better general health status. The 10th item asks respondents to rate their pain on average in the past 7 days on a 10-point scale, where 0 is no pain and 10 is the worst pain imaginable.

The Patient Health Questionnaire-8 will be used to assess depressive symptoms and psychosocial context. The Patient Health Questionnaire-9 total score ranges from 0 to 27 (scores of 5-9 are classified as mild depression; 10-14 as moderate depression; 15-19 as moderately severe depression; ≥ 20 as severe depression).

The Generalized Anxiety Disorder-7 questionnaire will be used to assess anxiety symptoms and psychosocial context. The Generalized Anxiety Disorder-7 score ranges from 0 to 21, where a higher score indicates greater anxiety.

The Primary Care PTSD Screen for DSM-5 (PC PTSD-5) is a 5-item measure used to assess trauma-related symptoms and psychosocial context. Scores range from 0 to 5, where the score is a count of 'yes' responses to 5 yes or no questions about the impact of the trauma in the previous month.

The International Physical Activity Questionnaire (IPAQ) short form will be used to assess physical activity. The IPAQ is a seven-item questionnaire that assesses the amount of time participants have spent doing physical activity (e.g., moderate physical activities, vigorous physical activities, walking) in the last seven days.

The Continence Diary - Pad Count will be used to assess pad use and continence patterns. Participants will record pad use for 7 typical days. Social continence is defined as 0 to 1 pad per day.

The Medication and Sexual Aids Inventory and Use Log will be used to track use of medications and sexual aids. The log captures whether items were used since the last survey, frequency, typical duration, and notes such as side effects, discomfort, bruising, and adjunct use.

Study-specific adherence and barrier items will be used to understand what makes the rehabilitation program easier or harder to follow. Items address PFPT adherence and barriers, sex therapy adherence and barriers if assigned, and VED use adherence and barriers.

The 15-STARS ED is a 15-item self-report questionnaire used to assess adherence to phosphodiesterase type 5 inhibitor medication when prescribed by the treating clinician. Sum scores range from 0 to 14 with higher scores indicating lower adherence.

Sexual avoidance will be assessed using a 4-item sexual avoidance questionnaire. This measure asks respondents to indicate how often they have avoided partnered and unpartnered sexual activity, respectively, on a scale of 0 (Never) to 4 (Always or Almost Always). If a response other than 0 is provided, respondents will be asked to check all options that apply from a list of reasons why they have avoided that type of sexual activity.

Sexual self-efficacy will be assessed using the 26-item Sexual Self-Efficacy Questionnaire. Participants indicate which activities they believe they can do and rate their confidence in being able to perform those activities on a 10 to 100 scale.

Sexual satisfaction will be assessed using the Sexual Satisfaction Questionnaire, a 4-item measure assessing respondents' agreement with 4 statements related to sexual satisfaction on a scale of 1 (Not at all) to 7 (Extremely). Higher scores indicate higher sexual satisfaction.

Sexual dysfunction will be assessed using a Sexual Dysfunction Questionnaire, a 4-item measure assessing respondents' agreement with 4 statements related to sexual dysfunction on a scale of 1 (Extremely) to 6 (None or Never). Higher scores indicate higher sexual dysfunction.

A study-spcific Sexual Health Information and Support Needs questionnaire will be used to assess the importance of educational and supportive programming topics related to sexual health after prostate cancer treatment. Respondents will be asked to rate the importance of 12 related topics on a scale of 1 (Unimportant) to 5 (Very important). Respondents will also have the option to self-specify 'other' topics and rate the importance of those topics.

Patient perceptions and opinions about guidelines will be assessed using 3 study-specific guideline perception items included in the questionnaire set.

The Acceptability of Intervention Measure will be completed by interventionists, providers, and research staff based on their experience delivering or supporting the study. Four items are rated on a 5-point agreement scale from "Completely disagree" to "Completely agree."

The Intervention Appropriateness Measure will be completed by interventionists, providers, and research staff based on their experience delivering or supporting the study. Four items are rated on a 5-point agreement scale from "Completely disagree" to "Completely agree."

The Feasibility of Intervention Measure will be completed by interventionists, providers, and research staff based on their experience delivering or supporting the study. Four items are rated on a 5-point agreement scale from "Completely disagree" to "Completely agree."