Prehabilitation and Prostate Cancer: Making the Waiting Time Count
Using the weeks between diagnosis and treatment to protect continence, fitness and confidence
A prostate cancer diagnosis is usually followed by several weeks of waiting before surgery, radiotherapy or hormone therapy begins. Prehabilitation turns that waiting period into preparation. It combines structured exercise, targeted pelvic floor training, nutritional support and psychological care so that men arrive at treatment with more physical and mental reserve than they would otherwise have.
What the research shows
• Continence recovers faster when training starts early. In a randomised trial of 97 men, a pelvic floor programme begun five weeks before radical prostatectomy produced significantly less urinary leakage and a faster return to continence than starting after surgery, alongside better quality-of-life scores.¹
• Pooled evidence supports the early continence benefit. A meta-analysis of randomised trials found preoperative pelvic floor muscle exercise improved continence at three months after surgery (OR 0.61, 95% CI 0.37–0.98).²
• Whole-body training adds to pelvic floor work. A 2025 systematic review of 642 participants concluded that programmes combining pelvic floor exercises with aerobic and resistance training deliver better functional recovery and continence outcomes than pelvic floor exercises alone — and that low-intensity programmes show little benefit.³
• Home-based prehabilitation works. In a multicentre randomised trial, men who completed a home-based, moderate-intensity exercise programme before prostatectomy walked significantly further four weeks after surgery and had greater grip strength at six months than usual-care controls.⁴
• The benefit is not only physical. A systematic review with meta-analysis across cancer types found prehabilitation significantly reduced both anxiety and depression scores, as well as improving walking capacity.⁵
Why a digital programme (digital prehabilitation) fits this pathway well
Much of what helps most, pelvic floor practice, walking, resistance work, sleep and diet changes, happens at home, not in a hospital gym. Delivering prehabilitation digitally (digital prehab) at home removes the travel, parking and time off work that cause people to drop out of hospital-based schemes; researchers designing current trials explicitly cite “burdensome commuting” as a threat to compliance.⁶ A systematic review of remote, technology-supported prehabilitation found it both feasible and highly acceptable to patients.⁷
Digital delivery also allows a level of personalisation that group clinics cannot match. Exercise intensity, pelvic floor volume and nutritional targets can be set from an individual’s baseline and adjusted continuously as fitness changes or hormone therapy begins. Crucially, the evidence on digital health is clear that technology alone is not enough: engagement and adherence improve markedly when a real, trusted human being provides coaching, feedback and supportive accountability.⁸ Providers built around this “human-in-the-loop” model, such as QuestPrehab, which delivers personalised prehabilitation remotely within NHS pathways or through self referrals, aim to combine the reach and tailoring of a digital prehab platform with the motivation that only a named clinician or coach can supply.
Sources
1. Milios JE et al. Pelvic floor muscle training in radical prostatectomy: an RCT. BMC Urol 2019;19:116. https://doi.org/10.1186/s12894-019-0546-5
2. Zhou L et al. Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: systematic review and meta-analysis. Front Public Health 2023;11:1186067. https://doi.org/10.3389/fpubh.2023.1186067
3. Pelvic floor rehabilitation before radical prostatectomy: a systematic review. BMC Urol 2025. https://doi.org/10.1186/s12894-025-01932-2
4. Santa Mina D et al. Prehabilitation for radical prostatectomy: a multicentre randomized controlled trial. Surg Oncol 2018;27:289–298. https://doi.org/10.1016/j.suronc.2018.05.010
5. Efficacy of prehabilitation in cancer patients: an RCTs systematic review with meta-analysis. BMC Cancer 2024;24:1302. https://doi.org/10.1186/s12885-024-13023-w
6. Kleve G et al. Digital home-based multimodal prehabilitation (dHOPE): trial protocol. Front Digit Health 2025;7:1609678. https://doi.org/10.3389/fdgth.2025.1609678
7. Blumenau Pedersen M et al. Digital technologies to support home-based prehabilitation: a systematic review. The Surgeon 2023;21:e305–e315. https://doi.org/10.1016/j.surge.2023.05.006
8. Application of the supportive accountability model in digital health interventions: scoping review. J Med Internet Res 2025;27:e72639. https://doi.org/10.2196/72639