Scoping Review Maps Prostate Cancer Self-Management Gaps

A comprehensive scoping review has mapped the existing landscape of self-management interventions for lower urinary tract symptoms (LUTS) following radical prostatectomy. The study, which analyzed 17 empirical studies conducted between 2008 and 2026, aims to clarify the specific components of these interventions and identify critical gaps in the current evidence base. By systematically organizing intervention content, providers, tools, and outcomes, the review provides a structured overview that distinguishes patient-led self-management from conventional conservative treatments. This distinction is crucial because while guidelines recommend pelvic floor muscle training and education, little is known about how patients sustain these behaviors in their daily lives.

The review followed the methodological framework proposed by Arksey and O’Malley and was reported in accordance with the PRISMA-ScR guidelines. Literature searches were conducted in PubMed, CINAHL, PsycINFO, and Web of Science, identifying 480 records initially. After removing duplicates and screening titles and abstracts, 38 full-text articles were assessed, resulting in the inclusion of 17 studies. These studies included 10 randomized controlled trials, four retrospective cohort studies, two quasi-experimental designs, and one pilot feasibility study. The geographic distribution of the research was uneven, with China accounting for the largest number of studies (n = 8), followed by the United States (n = 3), and single studies from Australia, Brazil, Japan, Sweden, Taiwan, and Turkey.

The definition of a self-management intervention used in this review was specific: a nursing intervention designed to enhance patients’ ability to proactively manage LUTS by supporting lifestyle modification, symptom management, and sustained self-care behaviors. Interventions consisting solely of conventional conservative management, such as pelvic floor muscle training (PFMT) or biofeedback delivered in isolation, were excluded unless they included additional components promoting active patient participation. This methodological choice allowed the researchers to focus on the complex, multifactorial nature of LUTS management rather than isolated clinical techniques. The sample sizes across the included studies ranged from 16 to 279 participants, with a mean sample size of 111.4, and participants’ mean age ranged from 56.8 to 76.4 years.

The interventions analyzed were typically multimodal, combining lifestyle modification, follow-up care, and LUTS-focused symptom management. Lifestyle modification components frequently included fluid intake management, restriction of caffeinated beverages, smoking cessation, and nutritional management. Follow-up care involved individualized patient support, often delivered through face-to-face interactions, telephone calls, or digital platforms. Symptom management included active monitoring, feedback provision, and education on the causes of urinary incontinence. These components were often integrated with complementary approaches such as PFMT, biofeedback, physical training, and psychological counseling, suggesting that effective self-management requires a comprehensive, tailored approach rather than a single technique.

Outcome measures varied significantly across the studies, limiting direct cross-study comparisons and precluding meta-analytic synthesis. Commonly used tools for assessing lower urinary tract function included the pad test, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and the International Prostate Symptom Score (IPSS). Quality of life was evaluated using instruments such as the Short Form Health Survey (SF-36/SF-12), the Expanded Prostate Cancer Index Composite (EPIC), and the King’s Health Questionnaire (KHQ). Psychological outcomes and self-efficacy were measured using scales like the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). This heterogeneity in outcome measures highlights a major gap in the literature, as the lack of standardized indicators makes it difficult to determine the relative effectiveness of different intervention strategies.

The findings revealed inconsistent results regarding the efficacy of these self-management interventions. Some studies reported significant improvements in urinary incontinence severity, quality of life, and psychological well-being in the intervention groups compared to controls. For instance, one study found that a nurse-led follow-up care intervention resulted in significantly greater improvement in urinary incontinence severity at 1-2 months postoperatively. Another study demonstrated that a cognitive-behavioral therapy-based intervention improved irritative and obstructive urinary symptoms at 3 months. However, other studies found no significant between-group differences in LUTS outcomes, and one study noted that urinary incontinence severity did not return to preoperative levels even at 12 months postoperatively. This variability underscores the need for more rigorous controlled studies to distinguish between natural postoperative recovery and intervention-specific effects.

Digital interventions emerged as a notable trend in the reviewed literature, with several studies utilizing mobile apps, web-based platforms, and telehealth tools to support self-management. These digital tools often included features such as personalized feedback, symptom tracking, goal setting, and remote nurse communication. For example, one study found that application usage declined over time, suggesting that sustaining patient motivation and engagement remains a significant challenge.

The review identified several key gaps in the current evidence base. First, there is a lack of standardization in intervention content, with studies varying widely in the specific components included and the intensity of support provided. Second, outcome measures are not harmonized, making it difficult to compare results across studies. Third, there is limited evidence on the long-term effectiveness of self-management interventions, with most studies focusing on short-term outcomes within 12 months of surgery. These gaps highlight the need for future research to focus on theory-based intervention design, standardized outcome measures, and long-term follow-up.

The implications for nursing practice are significant. The review suggests that nursing support for patients with LUTS following radical prostatectomy should emphasize helping patients maintain self-management behaviors in daily life rather than focusing solely on symptom improvement. This involves establishing a continuous support system that begins at the time of diagnosis and continues through the postoperative period. Nurses play a crucial role in assessing patients’ symptom management, addressing associated anxiety, and providing support that enhances self-efficacy. By helping patients develop staged, achievable goals and integrating self-management into their daily routines, nurses can contribute to improved quality of life and better long-term outcomes.

In conclusion, this scoping review provides a valuable overview of the current state of self-management interventions for LUTS following radical prostatectomy. It highlights the complexity of these interventions and the need for more standardized, theory-based research to clarify their effectiveness. The findings underscore the importance of a holistic approach to LUTS management that addresses both physical and psychosocial aspects of patient care. As the incidence of prostate cancer continues to rise, developing effective self-management strategies will be essential for improving the quality of life of patients undergoing radical prostatectomy. Future research should focus on identifying the most effective intervention components, standardizing outcome measures, and evaluating the long-term impact of self-management support on patient outcomes.

Subject of Research: Self‐Management Interventions for Lower Urinary Tract Symptoms After Radical Prostatectomy: A Scoping Review of Intervention Components, Outcomes and Research Gaps

Article Title: Self‐Management Interventions for Lower Urinary Tract Symptoms After Radical Prostatectomy: A Scoping Review of Intervention Components, Outcomes and Research Gaps

Article References: Amano, K., & Suzuki, K. (2026). Self‐Management Interventions for Lower Urinary Tract Symptoms After Radical Prostatectomy: A Scoping Review of Intervention Components, Outcomes and Research Gaps. Nursing Open, 13(11), Article e70991. https://doi.org/10.1002/nop2.70991

Image Credits: AI Generated

DOI: 10.1002/nop2.70991

Keywords: Self, Management, Interventions, Lower, Urinary, Tract, Symptoms, Radical, Prostatectomy, Scoping, Review, Intervention