Urinary incontinence is a common complication following radical prostatectomy and can significantly impact quality of life. Pelvic floor physiotherapy is recommended to reduce post-operative incontinence; however, referral pathways and patient engagement vary.

The PRO-ACT trial is a single-centre, parallel-group randomised controlled trial evaluating whether a structured pre-operative education bundle combined with direct physiotherapy referral reduces urinary incontinence following radical prostatectomy compared to standard care.

Eligible men undergoing radical prostatectomy at Beaumont Hospital will be randomised 1:1 to either:

Standard of care (educational video and recommendation for physiotherapy with patient-initiated referral), or

A structured pre-operative intervention including a one-to-one ANP-led education session, scheduled post-operative follow-up call, and direct referral to supervised pelvic floor physiotherapy.

The primary outcome is mean urinary pad usage per 24 hours at 3 months post-operatively. Secondary outcomes include time to continence, quality of life, physiotherapy adherence, and postoperative complication rates.

Radical prostatectomy is a definitive treatment for localised prostate cancer but is frequently associated with post-operative urinary incontinence. Pelvic floor muscle training has been shown to improve continence outcomes; however, inconsistent referral practices and limited early engagement may reduce effectiveness.

The PRO-ACT study evaluates whether a structured pre-operative pathway improves continence outcomes compared to standard care.

This is a prospective, single-centre, parallel-group randomised controlled trial conducted at Beaumont Hospital.

Participants will be randomised 1:1 to:

Control Group (Standard Care):

ANP recommendation for pelvic floor physiotherapy

Provision of educational video

Patient-initiated physiotherapy referral

No scheduled post-operative follow-up call

Intervention Group (PRO-ACT Bundle):

One-to-one pre-operative education session delivered by an Advanced Nurse Practitioner

Scheduled follow-up telephone call 7-10 days post-operatively

Direct referral to supervised pelvic floor physiotherapy

Follow-up will occur at 6 weeks and 3 months post-operatively.

The primary endpoint is mean pad usage per 24 hours at 3 months, measured using a 7-day pad diary. Secondary endpoints include time to continence (defined as 7 consecutive days with zero pad use), EQ-5D-5L quality-of-life measures, physiotherapy uptake, and 90-day postoperative complications.

Inclusion Criteria:

Male patients aged ≥ 18 years Diagnosis of prostate cancer Scheduled for radical prostatectomy (open, laparoscopic, or robotic-assisted) Able to provide written informed consent

Exclusion Criteria:

Pre-existing urinary incontinence requiring pad use Prior pelvic radiotherapy Prior prostate surgery affecting continence outcomes Medical contraindication to participation in pelvic floor physiotherapy

Inability to provide informed consent

Eligibility is based on biological sex due to the surgical indication and not restricted by gender identity beyond the clinical requirement.

Blinding is not feasible due to the behavioural and referral-based nature of the intervention. Participants, clinicians, and investigators will be aware of allocation. Outcome measures are primarily patient-reported (pad diary and questionnaires).