Equitable Reach, Engagement, and Mental Health Outcomes of a Digital Prostate Cancer Survivorship Program Across Rural and Urban Settings: Results from an International Phase 4 Trial

Purpose: Prostate cancer survivors frequently lack access to comprehensive survivorship care, particularly in rural settings. We evaluated whether a digitally delivered, multicomponent survivorship program demonstrated equitable implementation and comparable longitudinal psychosocial outcomes across rural and urban contexts in an international Phase 4 implementation trial. Materials and Methods: This ongoing Phase 4, single-arm, prospective international implementation study evaluated the Prostate Cancer Patient Empowerment Program (PC-PEP), a 6-month, home-based digital intervention. Participants with prostate cancer completed assessments at baseline and 6, 12, and 24 months. Rural vs urban participants were compared on demographics, follow-up, and evaluation metrics. Exploratory longitudinal generalized estimating equation (GEE) models assessed change in psychological distress (K10) and health-related quality of life (SF-12 Mental Component Summary [MCS]), adjusting for covariates, and tested for differential trajectories by rurality. Results: Among 689 participants (urban n = 483; rural n = 206), follow-up completion was similar between groups at 6 months (82.1% vs 77.5%), 12 months (66.5% vs 68.5%), and 24 months (59.9% vs 56.6%). Baseline psychosocial, functional, and symptom outcomes were comparable. Program acceptability was high with ≥ 92% of participants recommending PC-PEP and endorsing that it should be standard care. Rural participants rated pelvic floor muscle training and dietary guidance more favorably. Psychological distress decreased and SF-12 MCS improved over time, with no difference by rurality. Conclusions: PC-PEP demonstrated equitable reach, follow-up, and perceived usefulness across rural and urban settings, alongside sustained improvements in mental health outcomes. These findings support scalable, equity-oriented digital survivorship care for men with prostate cancer.