{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:38:45Z","timestamp":1788979125230,"version":"build-2803163510"},"reference-count":0,"publisher":"Canadian Urological Association Journal","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CUAJ"],"abstract":"<jats:p>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.\nMethods: 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.\nResults: Mean reported weekly PFMT duration did not differ between groups. The early group had higher compliance survey completion (98.8% vs. 64.1%, p&lt;0.001) and higher post-intervention EPIC urinary incontinence scores (81.5\u00b121.9 vs. 68.2\u00b117.0, p&lt;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.\nConclusions: 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.<\/jats:p>","DOI":"10.5489\/cuaj.9525","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T09:21:02Z","timestamp":1774948862000},"source":"Crossref","is-referenced-by-count":1,"title":["Mediation analysis of adherence to pelvic floor muscle training and weekly self-monitoring on urinary symptoms in men with localized prostate cancer"],"prefix":"10.5489","volume":"20","author":[{"given":"Emily","family":"Chedrawe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8577-3023","authenticated-orcid":false,"given":"Nathan K.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1602-6374","authenticated-orcid":false,"given":"Gabriela","family":"Ilie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo A.","family":"Rendon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Mason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Kokorovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cody","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhilesh","family":"Patil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bowes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Bailly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Abou-Samra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Bourne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam-Patrick","family":"Hagerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Rutledge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3456","published-online":{"date-parts":[[2026,3,30]]},"container-title":["Canadian Urological Association Journal"],"original-title":[],"link":[{"URL":"https:\/\/cuaj.ca\/index.php\/journal\/article\/download\/9525\/6777","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/cuaj.ca\/index.php\/journal\/article\/download\/9525\/6776","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T09:21:04Z","timestamp":1775035264000},"score":1,"resource":{"primary":{"URL":"https:\/\/cuaj.ca\/index.php\/journal\/article\/view\/9525"}},"subtitle":["A secondary analysis of the Prostate Cancer-Patient Empowerment Program (PC-PEP) randomized controlled trial"],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":0,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,3,30]]}},"URL":"https:\/\/doi.org\/10.5489\/cuaj.9525","relation":{},"ISSN":["1920-1214","1911-6470"],"issn-type":[{"value":"1920-1214","type":"electronic"},{"value":"1911-6470","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}