A Phase 2 interventional study of Tadalafil 5 mg and Pelvic Floor Muscle Training (PFMT) in Erectile Dysfunction Following Radical Prostatectomy, Prostate Cancer and Urinary Incontinence Following Surgical Procedure, sponsored by Surgical Outcomes Research Centre (SOuRCe). Recruiting at 3 sites in Australia. Open to male participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-10-23.
Sponsored by Surgical Outcomes Research Centre (SOuRCe) · Phase 2, Interventional, and Treatment
Prostate cancer is the most common cancer in Australian men. Robot-assisted radical prostatectomy (RARP) - surgical removal of the prostate - is a standard treatment, but it frequently causes erectile dysfunction (ED) and urinary incontinence that can persist for years and significantly affect quality of life.
This trial (ROBOPREP) will test whether a multimodal program of prehabilitation (before surgery) and rehabilitation (after surgery) improves erectile function and urinary continence in men undergoing RARP, compared to standard care alone.
The program includes four components, all delivered virtually and in a self-directed manner:
A total of 64 men will be recruited across three major Sydney hospitals (Royal Prince Alfred Hospital, Concord Repatriation General Hospital, and Chris O'Brien Lifehouse) and randomly assigned 1:1 to the multimodal program plus standard care, or to standard care alone. Outcomes - including erectile function (primary), urinary continence, quality of life, and psychological wellbeing - are assessed at baseline and at 6 weeks, 3, 6, and 12 months following surgery. All participant-facing elements of the program are digital, low-cost, and designed for real-world scalability.
The ROBOPREP Trial is a hybrid type 1 multicentre, assessor-blinded, parallel-group randomised controlled trial with nested qualitative and cost-effectiveness appraisal. The trial evaluates a virtually delivered, self-directed multimodal (p)rehabilitation program for men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer.
Background: Erectile dysfunction (ED) occurs in 25-75% of men following RARP, with unassisted recovery of erectile function in only 20-25%. Urinary incontinence affects a further 27-40%. Current evidence supports early initiation of phosphodiesterase type 5 inhibitors (PDE5i), pelvic floor muscle training (PFMT), and psychological interventions, but no multimodal perioperative program combining all modalities has been evaluated in a rigorous RCT.
Intervention: Participants randomised to the intervention arm receive, in addition to standard care: (1) tadalafil 5 mg/day orally commencing 4 weeks preoperatively, ceasing during hospital admission, and resuming for 3 months following postoperative catheter removal; (2) pelvic floor muscle training (3 sets/day: 20 fast and 20 slow contractions); (3) aerobic exercise (40 min, 4×/week, moderate-to-vigorous intensity); (4) nutritional guidance; and (5) psychological strategies including relaxation, psychoeducation, and self-compassion. Non-pharmacological components are delivered via a co-designed digital booklet and avatar videos. All components are self-directed to ensure scalability.
Randomisation and Blinding: Randomisation (1:1, stratified by age ≤60 vs >60 years, and nerve spare expected >50% bilateral or unilateral 100%, permuted blocks of size 2 and 4) is managed via a central secure REDCap randomisation module uploaded by an independent research officer. Outcome assessors are blinded to allocation; blinding of participants and treating clinicians is not feasible given the nature of the intervention.
Statistical Analysis: Primary analysis is intention-to-treat. The primary outcome (IIEF-5 at 3 months postoperatively) will be compared between arms using Mann-Whitney U tests and multivariate regression adjusting for baseline characteristics. Secondary outcomes will be analysed using mixed models, Cox regression (time to continence), and chi-square or Fisher's exact tests as appropriate.
The trial medication is funded by Generic Health (Lupin), who provide a donation covering participant reimbursement for tadalafil 5 mg (4-month supply; approx. AUD $120-150 per participant) and the TGA CTN application fee. Tadalafil 5 mg is TGA-approved for erectile dysfunction (ARTG: 289541).
7,046 studies on the registry are indexed under Prostatic Neoplasms; 1,580 are open to participants now.
This study's planned enrollment of 64 is close to the median of 60 across 5,348 interventional studies indexed under Prostatic Neoplasms.
Browse Prostatic Neoplasms studies →Surgical Outcomes Research Centre (SOuRCe) is the lead sponsor of 3 studies on the registry; 3 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².
Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.
Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.
The New York Heart Association’s four classes of how much heart failure limits physical activity.
Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
GFR and eGFR (kidney filtering)
GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².
Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Creatinine clearance (CrCl)
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
CYP3A (CYP3A4) inhibitors and inducers
CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.
Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
NYHA class (heart failure)
The New York Heart Association’s four classes of how much heart failure limits physical activity.
Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants receive standard care PLUS a multimodal program commencing ≥4 weeks preoperatively and continuing for 3 months postoperatively (following catheter removal). The program comprises four components: (1) tadalafil 5 mg orally once daily (paused during hospital admission); (2) pelvic floor muscle training 3 sets/day; (3) aerobic exercise 40 min, 4×/week; (4) nutritional guidance; and (5) psychological/wellbeing strategies. All non-pharmacological components are self-directed and digitally delivered.
Drug: Tadalafil 5 mg · Behavioral: Pelvic Floor Muscle Training (PFMT) · Behavioral: Aerobic Exercise Program · Behavioral: Nutritional Recommendations · Behavioral: Psychological and Wellbeing Strategies · Behavioral: Standard Perioperative Care
Participants receive usual high-standard perioperative care from their treating team, including clinical advice on exercise, nutrition, smoking cessation, alcohol reduction, expected surgical sequelae, and pelvic floor exercises, as well as medical considerations (blood sugar optimisation, medication review, anaemia screening). Prostate cancer nurse specialist consultations and urology clinic attendance are included as standard.
Behavioral: Standard Perioperative Care
Tadalafil 5 mg tablet, taken orally once daily. Commenced 4 weeks prior to surgery, ceased during hospital admission (3 days prior to surgery), and recommenced following postoperative urinary catheter removal (typically 5-10 days post-surgery) for 3 months. Total intended duration approximately 4 months. Supplied via standard prescription dispensing at community pharmacies (Generic Health brand). Reimbursement provided to participants via a cash card. TGA ARTG number: 289541.
Also known as: Tadalafil GH
Self-directed PFMT performed 3 sets per day. Each set comprises 20 fast contractions (1-second duration) and 20 slow contractions (10 seconds on, 10 seconds off). Adapted from Milios et al. (2020) using Continence Australia guidelines. Delivered via co-designed digital booklet and avatar instructional videos. Commenced 4 weeks preoperatively, continuing through 3 months postoperatively.
Self-directed aerobic exercise at moderate-to-vigorous intensity (e.g., brisk walking while able to maintain conversation), 40 minutes per session, 4 sessions per week. Dose established by Gerbild et al. (2018). Delivered via digital booklet and avatar videos. Commenced 4 weeks preoperatively, continuing through 3 months postoperatively.
Structured dietary guidance addressing protein intake, fruit and vegetable consumption, wholegrains, healthy fats, hydration, and blood sugar control. Designed by a dietitian to support surgical healing, vascular health, and erectile and urinary function recovery. Delivered via digital booklet and avatar videos. Commenced 4 weeks preoperatively, continuing through 3 months postoperatively.
Self-directed psychological wellbeing program comprising: (1) relaxation techniques (progressive muscle relaxation, diaphragmatic/rectangle breathing, mindfulness/grounding); (2) psychoeducation on psychogenic erectile dysfunction, expected postoperative complications (ED, UI); (3) self-compassion and cognitive reframing strategies; (4) motivational interviewing-style elements to support adherence; (5) advice on social connection, smoking cessation, alcohol reduction, and sleep hygiene. Designed by a clinical psychologist and delivered via digital booklet and videos. Commenced 4 weeks preoperatively, continuing through 3 months postoperatively.
Usual high-standard pre- and postoperative care delivered by the treating urological team, including clinical advice on exercise, nutrition, smoking cessation, alcohol reduction, expected surgical sequelae, pelvic floor exercises, blood sugar optimisation, medication review, and anaemia screening. Includes prostate cancer nurse specialist consultations and urology clinic follow-up.
Erectile Function - International Index of Erectile Function-5 (IIEF-5)
The IIEF-5 is a validated 5-item self-report questionnaire assessing erectile function over the preceding 4 weeks. Scores range from 5 (severe erectile dysfunction) to 25 (no erectile dysfunction). A between-group difference of ≥4 points constitutes the minimal clinically important difference (MCID) as established by Rosen et al. (2011). The IIEF-5 is the abbreviated version of the 15-item IIEF, widely used in prostate cancer rehabilitation trials.
Time frame: Assessed at 3 months postoperatively (primary endpoint). Also assessed at baseline (4 weeks preoperatively), 6 weeks, 6 months, and 12 months postoperatively.
Urinary Incontinence - ICIQ-UI SF
The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) is a validated 4-item patient-reported measure of urinary incontinence severity and impact on quality of life. Scores range from 0 (no incontinence) to 21 (severe incontinence). Assesses urinary leakage frequency, volume, and overall impact.
Time frame: Baseline (≥4 weeks preoperatively), 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Number of Urinary Pads Used in 24 Hours
Total number of urinary pads used by the participant over a 24-hour period, as self-reported. A higher number of pads indicates greater urinary incontinence severity.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Weight of Urinary Pads Used in 24 Hours
Total weight (grams) of urinary pads used over a 24-hour period. Pad weight is obtained by weighing pads before and after use and calculating the difference. Higher weight indicates greater urine leakage volume.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Maximum Urinary Flow Rate (Uroflowmetry - Q-max)
Maximum urinary flow rate (mL/s) measured by uroflowmetry during voiding. Higher values indicate better bladder outflow function.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Post-Void Residual Urine Volume
Volume of urine remaining in the bladder after voiding (mL), measured by bladder ultrasound or catheterisation. Lower post-void residual volumes indicate more complete bladder emptying.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Maximum Detrusor Pressure (Urodynamics)
Maximum detrusor pressure (cmH₂O) measured during urodynamic testing, reflecting bladder contractility and outflow resistance during voiding.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Health-Related Quality of Life - Short Form-36 Health Survey, Version 2 (SF-36v2)
The Short Form-36 Health Survey, Version 2 (SF-36v2) is a validated 36-item multidimensional self-report questionnaire assessing health-related quality of life across eight domains: physical functioning, role limitations due to physical health, role limitations due to emotional health, bodily pain, general health perceptions, vitality, social functioning, and mental health. Each domain score ranges from 0 to 100, with higher scores indicating better health-related quality of life in that domain. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores are derived (each ranging from 0 to 100; higher scores indicate better health).
Time frame: Baseline, 6 weeks, and 6 months postoperatively.
Anxiety and Depression - Hospital Anxiety and Depression Scale (HADS)
The HADS is a validated 14-item self-report questionnaire with two 7-item subscales assessing anxiety (HADS-A) and depression (HADS-D) severity. Each subscale is scored 0-21; scores ≥8 indicate probable caseness. Designed for use in medical settings with somatic symptoms excluded to avoid confounding.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Fear of Cancer Recurrence - Single-Item Scale (FCR-1)
A single-item 0-10 numerical rating scale measuring fear of cancer recurrence. Scores range from 0 (no fear) to 10 (maximum fear of recurrence), with higher scores indicating greater fear of cancer recurrence. This single-item scale has been demonstrated as equivalently effective to the short-form FCR scale in oncological populations.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Pain Intensity - Numeric Pain Rating Scale (NPRS)
The NPRS is a single-item 0-10 scale measuring current pain intensity (0 = no pain, 10 = worst imaginable pain). Widely used in surgical and oncological populations.
Time frame: Baseline, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Postoperative Complication Rate - Clavien-Dindo Classification of Surgical Complications
Proportion of participants developing postoperative surgical complications within 30 days of surgery, categorised under the Clavien-Dindo Classification of Surgical Complications. Grades range from I (minor complication requiring no specific treatment beyond standard medications) to V (death). Higher grades indicate more severe complications and represent a worse outcome. Assessed by the treating clinical team from medical records.
Time frame: Within 30 days postoperatively. Complications also monitored at 6 weeks, 3 months, 6 months, and 12 months.
Length of Hospital Stay
Total number of days from RARP surgery to hospital discharge, extracted from medical records.
Time frame: At hospital discharge (postoperative), assessed up to approximately 5 days.
Positive Surgical Margin Rate
Proportion of participants with histopathologically confirmed positive surgical margins on surgical pathology report. A positive surgical margin indicates residual tumour at the resection edge and represents an adverse oncological outcome.
Time frame: Following surgical pathology report, assessed within approximately 4 weeks of surgery.
Pathological Staging - Tumour, Node, Metastasis (TNM) Classification
Pathological TNM stage assigned from the surgical pathology report according to the Union for International Cancer Control (UICC) TNM classification system. Staging reflects the pathological extent of disease including primary tumour (T), regional lymph nodes (N), and distant metastases (M). Higher pathological stage indicates more locally advanced disease.
Time frame: Following surgical pathology report, assessed within approximately 4 weeks of surgery.
Tumour Grade - Gleason Score and International Society of Urological Pathology (ISUP) Grade Group
Gleason score (range 6-10; higher scores indicate less differentiated, more aggressive tumour histology) and International Society of Urological Pathology (ISUP) Grade Group (range 1-5; higher grade groups indicate more aggressive disease and a worse prognosis). Both are derived from the surgical pathology report and are reported together as they describe the same histopathological characteristic.
Time frame: Following surgical pathology report, assessed within approximately 4 weeks of surgery.
Adverse Pathological Features: Seminal Vesicle Invasion, Perineural Invasion, and Extraprostatic Extension
Proportion of participants with each of the following adverse pathological features identified on surgical pathology report: (1) seminal vesicle invasion (SVI - yes/no), (2) perineural invasion (PNI - yes/no), and (3) extraprostatic extension (EPE - yes/no). Each is reported as a proportion (%). Presence of these features indicates more locally advanced pathology and is associated with poorer oncological outcomes.
Time frame: Following surgical pathology report, assessed within approximately 4 weeks of surgery.
Incremental Cost-Effectiveness - Cost per IIEF-5 Improvement
Economic analysis estimating the incremental cost per point improvement in IIEF-5 score for the multimodal program versus standard care. Costing data will include inpatient hospitalisation costs (from SLHD Performance Unit), out-of-pocket participant costs (reimbursed medication), and research-related resource utilisation.
Time frame: At 6 months postoperatively.
Implementation Evaluation - RE-AIM Framework
The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework will be applied by investigators to evaluate the implementation of the trial, including reach of the eligible population, fidelity of intervention delivery, and potential for future adoption in clinical settings. Assessed via a structured investigator-completed survey.
Time frame: At trial completion (approximately 6 months postoperative of final participant).
Acceptability of the Multimodal Program to Participants
Assessed via a structured qualitative survey (Likert-scale and open-ended questions) and semi-structured interviews with intervention arm participants. Explores barriers and facilitators to engagement, satisfaction with the program, and experiences with pharmacological adherence including pharmacy logistics. Qualitative free-text data will be analysed using reflexive thematic analysis. This is a qualitative outcome and is not scored on a numerical scale.
Time frame: Following completion of the prehabilitation program, assessed at approximately 3 months postoperatively.
Physical Activity Level - International Physical Activity Questionnaire (IPAQ)
The International Physical Activity Questionnaire (IPAQ) is a validated self-report questionnaire measuring total physical activity across four domains (work, transport, domestic, and leisure) over the preceding 7 days. Total physical activity is expressed as metabolic equivalent of task minutes per week (MET-minutes/week). There is no defined upper limit to the score; higher values indicate greater levels of physical activity, which represents a better outcome.
Time frame: Baseline and 3 months postoperatively
Intensive Care Unit (ICU) Admission Rate
Proportion of participants admitted to the intensive care unit (ICU) during their postoperative hospital stay following RARP, extracted from medical records.
Time frame: At hospital discharge (postoperative), assessed up to approximately 5 days.
Intensive Care Unit (ICU) Length of Stay
Total duration of ICU admission (hours) for participants admitted to the ICU postoperatively, extracted from medical records. Assessed only in the subset of participants admitted to the ICU.
Time frame: At hospital discharge (postoperative), assessed up to approximately 5 days.
30-Day Hospital Readmission Rate
Proportion of participants admitted to hospital within 30 days of RARP surgery, for any cause. Assessed via participant self-report and medical records.
Time frame: 6-week postoperative assessment (capturing 30-day window).
Prostate Specific Antigen (PSA)
Serum PSA (ng/mL) extracted from medical records or pathology results.
Time frame: Baseline (preoperative), 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Plan to share: No — There is no plan to make individual participant data available to other researchers. All data will be stored securely for 15 years following trial closure in accordance with ICH-GCP, TGA, and HREC requirements. Aggregate de-identified results will be disseminated via peer-reviewed publications and conference presentations.
No publications or documents are linked to this record.
Started Aug 2026 (actual). Primary completion is estimated for Dec 2028, 27 months after the start.
Of 610 non-industry phase 2 interventional studies under Prostatic Neoplasms, half reached primary completion within 57 months of starting (the median), counting those still running; a quarter within 39 and three quarters within 86. This study's planned 27 months is below that.
Counting every sponsor, half of 724 studies reached it within 53 months; a quarter within 34 and three quarters within 80.
How these figures are worked out, and which studies are left out of them.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
Eligibility is decided by the study team. Share this record with your doctor or contact the team directly.
Contact study teamGet an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Studies of the drug tested here: Tadalafil
Surgical Outcomes Research Centre (SOuRCe)