For the roughly one in eight men who will be diagnosed with prostate cancer during their lifetime, radical prostatectomy remains one of the most common and effective curative treatments. Yet the surgery carries a heavy functional price: damage to the delicate nerves and muscles surrounding the prostate can leave patients grappling with urinary incontinence and erectile dysfunction, complications that profoundly shape quality of life long after the tumor itself has been removed. Now, a new systematic review and meta-analysis published in Supportive Care in Cancer offers the most rigorous synthesis to date of whether preparing the body before the operation—so-called prehabilitation—can soften that blow. The verdict is nuanced but encouraging: structured preoperative training measurably reduces early urinary incontinence and improves quality of life in the first months after surgery, even though its effects on incontinence severity and erectile function remain stubbornly unclear.
The study, led by Wenxue Wan of the School of Nursing at China Medical University in Shenyang, together with colleagues at Kunshan First People’s Hospital, pooled data from sixteen randomized controlled trials encompassing 1,542 participants. Randomized controlled trials are considered the gold standard of clinical evidence because they minimize the confounding that plagues observational research, and by combining them statistically, the researchers gained the power to detect effects that individual small trials might miss. The team searched four major biomedical databases—PubMed, the Cochrane Library, Embase, and CINAHL—and followed established systematic review methodology, with two reviewers independently performing study selection, data extraction, and risk-of-bias assessment. The review was prospectively registered with PROSPERO, the international registry for systematic review protocols, under registration number CRD420251183407.
The interventions examined under the prehabilitation umbrella were diverse but shared a common logic: strengthen and condition the body’s functional reserve before surgical stress depletes it. Most trials centered on pelvic floor muscle training, in which patients learn to consciously contract and relax the levator ani muscles that support the bladder and urethra. Some programs added biofeedback, using sensors to give patients real-time visual or auditory cues about whether they were engaging the correct muscles, a technique designed to overcome the difficulty many men face in identifying these internal muscles without guidance. Other trials incorporated broader exercise regimens, stress management interventions, or combinations of physical and psychological preparation delivered in the weeks between diagnosis and surgery.
The headline finding concerns urinary incontinence, arguably the most feared functional consequence of prostate removal. The meta-analysis showed that prehabilitation significantly reduced the incidence of postoperative incontinence at one month after surgery, with an odds ratio of 0.58 and a 95 percent confidence interval of 0.39 to 0.84. In practical terms, men who trained before their operation were roughly 42 percent less likely to be incontinent at the one-month mark than those who received usual care. The benefit persisted at six months, where the odds ratio of 0.52 (95 percent confidence interval 0.28 to 0.96) indicated a similar magnitude of protection. At three months, the reduction was borderline but did not reach conventional thresholds of statistical significance, and by twelve months after surgery, the difference between the prehabilitation and control groups had disappeared entirely.
That temporal pattern tells a coherent physiological story. Radical prostatectomy involves dissecting the prostate away from the external urethral sphincter and the pelvic floor musculature, causing direct trauma, inflammation, and temporary loss of neuromuscular coordination in the region. In the early recovery phase, continence depends heavily on the compensatory strength and motor control of the remaining pelvic floor muscles. Prehabilitation appears to give patients a head start: men who arrive at surgery with conditioned, well-innervated pelvic floors can recruit those muscles more effectively while the surgical insult heals. As natural recovery proceeds over the following year, the baseline gap between groups narrows, because many men in the control group eventually achieve continence through spontaneous healing and any postoperative rehabilitation they receive. Prehabilitation, in other words, seems to accelerate the trajectory to continence rather than raise its ultimate ceiling.
Notably, the analysis drew a sharp distinction between the incidence of incontinence and its severity. Across all follow-up time points, prehabilitation produced no significant improvement in the severity of leakage among those affected. This suggests that conditioning the pelvic floor before surgery may help more men cross the threshold from leaking to dry, but it does not appear to make the incontinence milder in men who would leak regardless. Whether more intensive or longer preoperative programs could shift severity outcomes remains an open question that the included trials were not designed to answer definitively.
The picture for erectile function was similarly sobering. Despite biological plausibility—improved vascular health and muscle function could theoretically support erectile recovery—no significant benefit of prehabilitation on erectile function emerged at any follow-up time point. This is a clinically important negative finding, because sexual dysfunction after prostatectomy is driven largely by injury to the cavernous nerves that run alongside the prostate, structures that no amount of preoperative exercise can protect. Recovery of erectile function also typically unfolds over one to two years, longer than most trials followed their participants, and it depends heavily on surgical technique, nerve-sparing status, and patient age—factors that may overwhelm any modest prehabilitation effect.
Where the analysis did find durable and meaningful benefit was in quality of life. Prehabilitation significantly improved quality-of-life scores within the first three months after surgery, with a standardized mean difference of negative 0.70 (95 percent confidence interval negative 1.08 to negative 0.32), a moderate-to-large effect by conventional benchmarks. The benefit remained statistically significant at six months, with a standardized mean difference of negative 0.45 (95 percent confidence interval negative 0.74 to negative 0.16). By twelve months, the effect had attenuated to a marginal trend that did not reach statistical significance, with a standardized mean difference of negative 0.33 and a confidence interval of negative 0.66 to 0.00 that just touched the null. Standardized mean differences allow researchers to combine quality-of-life scores measured with different instruments across trials, and values in this range correspond to improvements patients themselves would typically perceive as meaningful.
The authors assessed the methodological quality of the included trials using the Cochrane Collaboration’s RoB-2 tool, the current standard for evaluating bias in randomized trials, and judged the overall risk of bias to be moderate. Statistical analyses were performed with Stata 18.0 software, with the researchers choosing between fixed-effects and random-effects models according to the degree of heterogeneity observed across trials—a crucial step, since the included studies varied in their interventions, comparators, and outcome measures. The team reported no funding for the preparation of the manuscript and declared no competing interests, and no new primary data were generated, as all findings derive from previously published studies.
The implications for clinical practice are tangible. The window between a prostate cancer diagnosis and radical prostatectomy, which can span several weeks while patients await surgery, represents an underused therapeutic opportunity. The findings suggest that even relatively brief preoperative pelvic floor training programs can meaningfully improve the most vulnerable early recovery period, when patients are most distressed by leakage and its impact on daily living. At the same time, the analysis tempers expectations: men should understand that prehabilitation does not appear to prevent long-term incontinence, does not improve its severity, and does not protect erectile function. Future research, the authors’ findings imply, should focus on identifying which patients benefit most, optimizing the dose and duration of preoperative training, and determining whether combining prehabilitation with structured postoperative rehabilitation can extend the early gains into lasting functional recovery.
Subject of Research: Effects of preoperative prehabilitation on urinary continence, erectile function, and quality of life after radical prostatectomy for prostate cancer
Article Title: The impact of prehabilitation on postoperative outcomes in patients undergoing radical prostatectomy for prostate cancer: a systematic review and meta-analysis
Article References: Wan, W., Shen, L., Chang, Y., & Jin, X. (2026). The impact of prehabilitation on postoperative outcomes in patients undergoing radical prostatectomy for prostate cancer: a systematic review and meta-analysis. Supportive Care in Cancer, 34(10), Article 971. https://doi.org/10.1007/s00520-026-11182-z
Image Credits: AI Generated
DOI: 10.1007/s00520-026-11182-z
Keywords: prehabilitation, prostate cancer, radical prostatectomy, urinary incontinence, erectile dysfunction, quality of life, pelvic floor muscle training, biofeedback, meta-analysis, systematic review, postoperative outcomes, supportive care
News Source: Ophelia Keating. (October 13, 2026). Prehabilitation Before Prostate Surgery Cuts Early Incontinence and Boosts Quality of Life, Meta-Analysis Finds. Scienmag.
