The impact of digital interactive interventions on survivorship outcomes in prostate cancer: a systematic narrative review.

Background
Prostate cancer (PCa) is the second most common cancer and the fifth leading cause of cancer-related death among men globally [1]. Due to global population growth and aging, the number of PCa cases is expected to rise significantly, reaching 2.4 million cases and 712,000 deaths by 2040 [2]. PCa generally has a favorable prognosis, with a five-year relative survival rate of approximately 98% [1]. As survival rates improve, PCa survivors are increasingly exposed to age-related health issues, long-term treatment complications, and reduced physical activity [3]. Therefore, the management of PCa is complex, involving a range of symptoms, treatment modalities, and associated side effects. These side effects often contribute to psychological distress and a reduced quality of life (QoL) among PCa survivors [4].
PCa survivors frequently face multifaceted challenges, including emotional difficulties such as anxiety, depression, and diminished self-esteem, as well as sexual dysfunctions including erectile and orgasmic difficulties, reduced libido, and sexual distress. Additionally, common physical side effects such as urinary incontinence, pain, and fatigue further impair their daily functioning and overall well-being [5, 6]. Although the most severe side effects tend to occur within the first 6 to 12 months after treatment, many symptoms persist for 4 to 8 years, underscoring the long-term impact of PCa [7]. For instance, men with PCa often live with a sense of insecurity, characterized by persistent fears of an incomplete cure and cancer recurrence [8]. Consequently, effective symptom control and supportive care are essential to improve survivors’ QoL and long-term health outcomes [9].
In recent years, digital interactive interventions have emerged as promising strategies for supporting cancer survivors in managing their symptoms. These technologies offer personalized, accessible, and scalable solutions that empower individuals to monitor symptoms, receive tailored feedback, and engage in self-care [10]. Digital health interventions offer an accessible, practical, and widely accepted approach to delivering health information and ensuring continuous support for patients between medical appointments, a strategy that was extensively utilized during the COVID-19 pandemic [11]. A recent meta-analysis showed that digital health interventions can be an acceptable and effective approach for enhancing QoL, reducing distress, improving self-efficacy, and alleviating fatigue in patients with breast cancer [12]. A scoping review of 66 studies highlighted the role of digital health solutions in oncology supportive care. Several digital tools effectively supported patient self-management, improved symptoms, enhanced QoL, and provided reassurance and practical value [13]. Another systematic review highlighted that eHealth tools, including web platforms and apps, improved communication, symptom management, and PCa shared care, with potential benefits for reducing anxiety and enhancing outcomes [9]. Additionally, a pilot study indicated that digital health coaching is a viable approach for supporting men with PCa [14].
Although several reviews have examined digital health and telehealth interventions across oncology [10, 12], and some have specifically addressed PCa survivorship care [9, 11], important gaps remain. Existing reviews vary considerably in scope, methodological focus, and the range of outcomes assessed. For example, a recent meta-analysis focused exclusively on mobile health (mHealth) interventions and included only randomized controlled trials (RCTs), thereby covering a narrow set of PCa specific outcomes and excluding web-based platforms, teleconsultation, and broader digital self-management tools increasingly used in survivorship care [11]. Another systematic review synthesized digital-based interventions across mixed cancer populations, limiting its relevance to PCa specific domains such as urinary, bowel, sexual, and hormonal function [15]. However, earlier digital behavior-change reviews were confined to lifestyle outcomes such as physical activity, diet and did not address the multidimensional needs of PCa survivors [16]. More recently, a systematic review of eHealth platforms for PCa shared care highlighted the potential of web platforms, patient portals, and apps to enhance communication, symptom monitoring, and holistic assessment. Its focus was on shared-care delivery models rather than survivorship outcomes and did not provide an outcome-wide synthesis of physical, functional, psychological, or QoL domains [9].
Despite this growing literature, no existing review has provided a comprehensive, integrated evaluation of all types of digital health interventions exclusively during the survivorship phase of PCa, across the full range of outcomes including urinary, bowel, sexual, and hormonal function, psychological well-being, lifestyle behaviors, self-management, and QoL. Given the increasing number of PCa survivors and the rapid expansion of digital tools in follow-up care, a unified and up-to-date synthesis is needed. Therefore, the present review aims to systematically identify and synthesize evidence on the effectiveness of digital interactive interventions on key survivorship outcomes in PCa. By offering a comprehensive, outcome-wide evaluation, this review advances the existing literature and provides evidence to guide future digital survivorship intervention development and clinical practice.

Methods

Protocol and registration
To ensure the methodological rigor and transparency of this systematic narrative review, we adhered to the guideline outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Table S1). The review protocol was registered on PROSPERO (registration number: CRD42025649190, publicly accessible via https://www.crd.york.ac.uk/PROSPERO/view/CRD42025649190). This review utilized the PICOS framework to define the scope and focus of the systematic review. The PICOS criteria, an acronym for Population, Intervention, Comparison, Outcomes, and Study design, have been detailed as follows:

P (population): Survivors of with PCa.

I (intervention): Utilization of digital interactions.

C (comparison): Non-digital forms of interactions such as traditional and face to face.

O (outcome): Physical and psychological survivorship outcomes.

S (Study design): Interventional research designs.

Search process
Relevant keywords were identified through an initial search on Google Scholar, drawing on the authors’ experiences with the research topic. A comprehensive literature search was conducted across multiple databases, including Web of Science, PubMed (including Medline), Scopus, Embase, and CINAHL, with no restrictions on publication date to retrieve articles published in English, up to May 2025. The identified keywords were used as entry terms and combined with AND/OR operators to refine the search strategy (Table S2). To ensure the thoroughness of the search, a manual search in the reference lists of relevant articles and leading journals was undertaken.

Study selection
This systematic review focused on clinical trials, quasi-experimental studies, and other interventional research conducted on human participants with a focus on digital interactions for symptom management and survivorship outcome in PCa survivors. Reviews, observational studies, qualitative research, case studies, case reports, discussions, commentaries, letters, books and conference proceedings were excluded. Studies using telephone calls as the sole intervention were excluded to preserve the focus on newer digital interactive approaches.

Screening
The search process was conducted by two authors (AM, MM) with knowledge and expertise in PCa survivorship and systematic review methodology. In the screening process, they independently screened the titles of all retrieved articles based on the predetermined inclusion and exclusion criteria. In the subsequent stage, they screened the abstracts of the selected studies. Using EndNote software, they shared their findings and discussed which articles met the inclusion criteria for further consideration. After the initial screening, they independently read the full text of each article twice and evaluated them against the inclusion criteria. Any disagreement was resolved through discussion, and when necessary, the input of another review author was sought.

Risk of bias assessment
To assess the methodological quality and risk of bias of the included studies, validated tools appropriate to each study design were used. For RCTs, including crossover and secondary analyses, the Cochrane Risk of Bias 2 (RoB 2) tool helped evaluate bias arising from the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result [17]. For non-randomized studies with a control group, such as quasi-experimental or non-randomized comparison studies, the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was used. Confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, outcome measurement, and selection of reported results were assessed using this tool [18]. Single-arm intervention studies and pre-post designs without a control group were evaluated using the NIH Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group, which considers clarity of study objectives, eligibility criteria, participant selection, outcome measures, follow-up completeness, statistical analyses, and potential confounding [19]. Each study was independently assessed by two reviewers, and disagreements were resolved through discussion to ensure consistency in risk-of-bias evaluation.

Data analysis and synthesis of results
Two independent reviewers (A.M. and M.M.) extracted data using a pre-designed standardized table that included author, year of publication, country, study design, sample characteristics, intervention details (content, delivery mode, duration, frequency), outcome measures, follow-up duration, and key findings. The feasibility of conducting a meta-analysis was formally assessed. As shown in Tables 1, 2 and 3, the included studies exhibited substantial clinical heterogeneity in terms of mixed disease stages, and diverse treatment pathways. Interventions differed markedly in type, intensity, content, and duration, ranging from mobile apps and web-based programs to telehealth coaching and wearable-integrated platforms. Comparator conditions were highly inconsistent, including usual care, enhanced usual care, educational materials, waitlist controls, and single-arm designs. Outcome heterogeneity was pronounced, with more than 40 instruments and variable measurement time points across similar domains. Methodological diversity in RCTs, crossover trials, quasi-experiments, non-randomized studies, and pilot single-arm designs further limited comparability, and reporting formats often precluded extraction of compatible effect estimates.
Therefore, a narrative synthesis was performed following the Synthesis Without Meta-analysis (SWiM) guideline [43]. Results were grouped by major survivorship outcome domains as urinary, bowel, hormonal, sexual, sleep/fatigue, QoL, psychological well-being, self-efficacy, and physical activity. In the narrative synthesis, primary interpretive weight was placed on evidence from the RCTs and findings from other designs were considered supportive rather than definitive.

Ethical considerations
The ethical approval for this study was granted by the Ethics Committee of Qazvin University of Medical Sciences (Decree code: IR.QUMS.REC.1404.227). Although this study did not involve direct human participant interaction, ethical standards were upheld by ensuring accurate, respectful use of data from original studies, maintaining transparency, integrity, and proper attribution. To reduce bias, multiple researchers independently screened and appraised quality, followed by consensus discussions.

Results
The results of our search across six databases are presented in Fig. 1. A total of 2,422 records were identified through database searching. After removing duplicates and screening titles, the abstracts of the remaining 180 articles were assessed against the inclusion criteria, resulting in the exclusion of 152 articles. The main reasons for exclusion at this stage were lack of focus on digital interventions (n = 62), absence of an interventional design (n = 57), and not PCa specific (n = 33). Twenty-eight full-text articles were then reviewed in detail, of which four were excluded because they did not focus solely on PCa survivors. Ultimately, 24 studies met the eligibility criteria and were included in the qualitative synthesis.

Risk of bias assessment
The risk of bias results for RCTs and non-RCT studies are presented in Figures S1 and S2, respectively. The risk of bias assessment for RCTs showed that all studies were judged as having some concerns. The majority of trials demonstrated a low risk of bias in relation to deviations from intended interventions, missing outcome data, and selective reporting. However, recurrent concerns were identified in the domains of the randomization process and measurement of outcomes. In addition, the collective risk of bias assessment for non-RCT studies indicated a high overall risk in one study due to serious bias in deviations from intended interventions, with moderate risk in bias due to classification of interventions, and no information available for bias in the selection of the reported result. Other studies showed a moderate overall risk, with low risk in domains like bias due to confounding and bias due to selection of participants, and ranged from low risk of bias, moderate risk of bias, and no information in other domains. Furthermore, the quality assessment using the NIH tool for before-after (pre-post) studies with no control group revealed that most studies clearly stated their objectives and population, with consistent intervention delivery, though sample sizes were often insufficient, and outcome blinding was not reported. Statistical tests for pre-to-post changes were generally conducted, but loss to follow-up and multiple outcome measures over time were inconsistently addressed (Table S3).

General charactristics of included studies
As it has been shown in Table 1, 24 primary studies published between 2012 and 2024 were included. They examined the role of digital interactive interventions in the management of symptoms among PCa survivors. The included studies originated from United States [14, 20, 28, 31, 37, 40, 42], Australia [21–23, 41], Canada [25, 26, 29, 38], China [24, 34], South Korea [30, 33], Sweden [36, 39], Germany [27], Japan [35], and United Kingdom [32]. A variety of study designs were employed including randomized trial [20–22, 24–26, 28–30, 33, 37, 39–42], single-arm interventional [14, 31, 32, 35], quasi-experimental [23, 27], retrospective [34], non-randomized [36, 38].
Sample sizes varied widely, from 15 participants in a small pilot of telehealth cognitive behavioral therapy (CBT) for sleep outcome [31] to 463 participants in a peer-led exercise self-management trial [22]. Participants’ mean ages ranged from the early 60 s to late 60s. Studies included patients across disease stages, from localized to advanced.

Intervention characteristics
Table 2 summarizes the core characteristics of the digital interactive interventions evaluated across the included studies. The digital interactive interventions included in this review displayed considerable heterogeneity in content, delivery mode, and duration, yet shared a common objective of addressing symptom burden, enhancing self-management skills, and improving overall QoL in PCa survivors. Several web-based self-management platforms offered structured educational content, interactive exercises, and behavioral support. These ranged from group-based cognitive behavioral stress management (CBSM) programs delivered weekly via tablet [20, 42], to the My Road Ahead six-module online psychological program with optional peer discussion forums [41], and the PCa online guide and resource for electronic survivorship (PROGRESS) platform focusing on values clarification, coping skills, and goal-setting [37]. Other tailored platforms targeted specific domains such as sexual rehabilitation, including the TrueNTH sexual recovery intervention [40] and a UK-developed 3-month web-based program to improve sexual well-being and communication [32]. Broader lifestyle and survivorship needs were addressed by multi-component interventions such as TEMPO, a dyadic, web-based psychosocial and physical activity self-management program tailored to the needs of men with PCa and their caregivers [26], and the prostate cancer patient empowerment program (PC-PEP), a 6-month online home-based package integrating physical, mental, and social health components, patient activation, pelvic floor training, and stress management [25, 29]. Other web-delivered models incorporated dietary and exercise prescription with optional wearable integration and coaching calls [28]. Group-based and peer-led formats were also represented, such as monthly telephone peer support alongside self-management materials [22] and structured web chat groups following national guidelines [27]. Mindfulness-based cognitive therapy (MBCT), delivered weekly by teleconference for eight weeks, was another example of a psychological skills–focused digital intervention, targeting distress reduction in advanced PCa [21].

Mobile health (mHealth) and telehealth modalities played a central role in many interventions. Symptom monitoring and tailored feedback were delivered via smartphone applications such as Interaktor for radiotherapy patients [36], electronic patient activation in treatment at home (ePATH) for post-prostatectomy recovery and pelvic floor training [39], and a mobile internet–based continuing care model incorporating WeChat communication and multidisciplinary oversight [34]. Telenursing approaches, such as the Japanese 3-month postoperative program used tablets for daily logging of urinary, sexual, and lifestyle outcomes, triggering personalized nurse feedback [35]. Telehealth coaching and education included a 12-week digital health coaching program using phone calls and digital nudges [14], nurse-led virtual survivorship care via teleconferencing [23], and tele-CBT for insomnia [31]. The proactive health management program developed in China represented a blended digital–human approach, combining health education, video resources, daily reminders, and weekly WeChat content with nurse-led online monitoring and follow-up calls to improve symptoms, self-care, and self-efficacy [24]. Wearable and IoT-based systems further expanded capabilities, as in the Smart After-Care Service combining smartbands, diet and exercise programs, and clinician monitoring [33], and nurse-led mobile coaching with pedometers, exercise diaries, and resistance bands [30]. Educational interventions were also delivered in online formats for men on androgen deprivation therapy (ADT), covering evidence-based management of treatment side effects [38]. Durations ranged from 4 weeks to 12 months, with contact frequency spanning daily symptom tracking to monthly follow-ups, and most interventions employed multi-component delivery strategies to sustain engagement and facilitate long-term behavior change.
Across the 13 studies reporting feasibility, acceptability, or engagement, most digital interventions showed favorable user uptake. High adherence was observed in tele-MBCT (83–100%) [21] and strong retention and attendance were reported in web-based CBSM (> 85% retention; >70% attendance) [42]. Peer-led and digital health–coaching programs demonstrated moderate feasibility (median 4 sessions; 60%) [14, 22], while nurse-led virtual care achieved very high acceptability (≥ 4/5) [23]. Telenursing systems showed particularly strong engagement, with 76.6% logging in daily and ~ 90% using the system regularly (≥ 5 times/week) [35]. Web-based group and dyadic programs such as chat forums and TEMPO reported acceptable usability and moderate adherence [26, 27]. Sexual well-being platforms demonstrated good usability (82%) and sustained engagement (51% completing ≥ 4 sessions; 65% active at month 3) [32], and other self-guided programs showed variable but positive use, including high satisfaction in sexual recovery modules (73–89%) [40], active use of the PROGRESS platform (38.7%) [37], and 59% module completion in My Road Ahead [41]. Nurse-tailored long-term platforms like ePATH also showed good user acceptability (64%) [39]. Remote teleCBT-I was also rated highly acceptable, with participants valuing convenience and privacy [31]. Collectively, these findings indicate that digital survivorship interventions are broadly feasible, acceptable, and capable of maintaining meaningful engagement across diverse formats.

Impacts of digital interactive interventions
Given the considerable clinical and methodological heterogeneity and the inability to perform meta-analysis, the following narrative synthesis was conducted. For clarity and clinical relevance, findings are reported below in six major outcome categories that emerged consistently across the evidence base: symptom-related outcomes, QoL and well-being, psychological outcomes and coping, self-efficacy and self-care capacity, physical activity and functional outcomes, and education/knowledge outcomes.
Table 3 presents the outcome measures used across studies and synthesizes the key findings for each survivorship domain. In addition, Table 4 provides a concise summary of the effectiveness of digital interactive interventions across survivorship outcome domains. It reports the total number of studies and the proportion of RCTs versus other designs, the number and percentage of studies that reported any beneficial effect, and an overall direction-of-effect judgment that gives primary weight to higher-quality evidence.

Symptom-related outcomes

Urinary Symptoms
Thirteen studies reported urinary outcomes. Of these, eight were RCTs [20, 22, 24, 29, 30, 33, 37, 39] and five employed non-randomized or single-arm designs [14, 23, 31, 35, 36]. In the PC-PEP, a 6-month intervention involving daily educational emails, exercises, and stress reduction strategies, participants showed significant improvements in urinary continence and reductions in irritative and obstructive urinary symptoms, with benefits sustained at 12-month follow-up [29]. Similarly, CBSM interventions delivered via web-based group sessions significantly reduced urinary irritation and incontinence at 6 months, and urinary irritation at 12 months in men with advanced PCa [20]. Moreover, nurse-led 12-week virtual survivorship care significantly improved urinary irritative and obstructive symptoms and reduced the burden of urinary dysfunction. Participants also experienced significant decreases in distress and urinary-related problems. Although clinical improvements in urine dripping or leakage, nocturia, and daytime frequency were observed, these changes were not statistically significant [23].
Mobile health coaching programs, which included personalized activity plans and self-care resources, were also associated with measurable reductions in urinary irritative and obstructive symptoms [30]. The Interaktor smartphone application, used during radiotherapy, enabled daily symptom monitoring with real-time clinician feedback, resulting in lower reported urinary problems [36]. Likewise, a 3-month telenursing intervention using tablet-based monitoring improved urinary function and reduced episodes of urinary incontinence following PCa surgery [35]. Additionally, a 12-week digital health coaching program combining telephone calls and digital nudges significantly improved urinary irritation, obstruction, function, and incontinence scores [14].
Furthermore, a 3-month proactive health management program, which included health education, manuals, video resources, weekly WeChat content, daily reminders, and psychological support alongside online nurse monitoring and weekly phone follow-ups significantly improved urinary function [24]. Similarly, a 12-week IoT-based smart after-care program for PCa patients on ADT improved urinary symptoms more effectively than face-to-face education [33]. In contrast, the study by Tagai et al. found that both the web-based PROGRESS program and enhanced usual care groups showed improvements in urinary incontinence and irritation without significant differences between groups [37].
However, not all interventions demonstrated significant benefits. For example, the ePATH intervention, which involved cancer nurse specialists tailoring web- and app-based self-care modules focusing on pelvic floor exercises, physical activity, and sexual rehabilitation did not produce statistically significant differences in urinary continence compared to standard care over the intervention period [39]. Similarly, self-management materials combined with monthly telephone-based peer support to increase exercise showed no significant differences between groups in urinary domains [22]. Lastly, a 4-week tele-CBT program for men with PCa undergoing ADT reported no significant changes in nocturia or urinary symptoms [31].

Bowel symptoms
Eight studies reported bowel outcomes. Of these, five were RCTs [20, 22, 29, 33, 37] and three employed non-randomized or single-arm designs [14, 35, 36]. They were less commonly targeted than urinary or sexual outcomes in interventions. However, web-delivered CBSM demonstrated both short-term (6-month) and longer-term (12-month) improvements in bowel function [20]. Similarly, a 3-month structured telenursing pathway combining daily tablet-based symptom logs, automated triggers, and biweekly clinician contact resulted in significant reductions in postoperative bowel complaints [35]. By contrast, trials focusing on general education and peer support reported no significant changes in bowel-domain scores [14, 22]. Furthermore, although the Interaktor app facilitated daily symptom reporting and nurse monitoring during and after radiotherapy, both the intervention and control groups experienced increases in diarrhea and bowel symptoms [36]. Likewise, no significant differences in bowel dysfunction were observed between groups in the web-based PROGRESS program [37]. In addition, no significant differences were observed between groups in bowel scores following the six-month home-based PC-PEP intervention [29]. The 12-week smart after-care intervention, featuring tailored exercise routines, monitoring of physical activity and diet, and support from a multidisciplinary team, did not result in significant differences in bowel symptoms compared to standard face-to-face education [33].

Hormonal symptoms
Nine studies reported hormonal symptoms, of which five were RCTs [20, 22, 24, 29, 33] and four employed non-randomized or single-arm designs [14, 31, 35, 36]. Several digital interventions reported improvements in hormonal function or composite hormonal symptom scores. For example, a 10-week online CBSM program demonstrated significant long-term improvements in hormonal function at 12 months [20]. A 12-week digital health coaching program also showed significant reductions in hormonal symptoms [14]. Telenursing interventions that combined symptom logging with timely clinician feedback yielded gains in the hormonal domain [35]. Additionally, a 4-week tele-CBT program for insomnia reduced the frequency and bother of hot flashes [31].
However, other interventions reported no significant effects on hormonal symptoms. A six-month home-based PC-PEP program showed no significant differences in hormonal, sexual, or bowel function [29]. Similarly, a proactive health management program failed to produce significant changes in sexual and hormonal function [24]. The 12-week smart after-care program, which included personalized exercise plans, activity and diet monitoring, and multidisciplinary counseling, also had no significant effect on hormonal symptoms compared to face-to-face education [33]. Moreover, use of the Interaktor app for daily symptom reporting and nurse monitoring during radiotherapy was associated with a significant increase in hormone-related symptoms in both intervention and control groups [36]. Finally, a peer-led self-management program found no significant differences between groups in hormonal symptoms [22].

Sexual Symptoms
Thirteen studies reported sexual symptoms. Of these, eight were RCTs [20, 22, 24, 29, 33, 37, 39, 40] and five employed non-randomized or single-arm designs [14, 23, 32, 35, 36]. Some interventions demonstrated positive effects: a 3-month structured web-based sexual well-being program improved knowledge of sexual health and sexual satisfaction [32], while an IoT-enabled lifestyle program combining individualized physical activity prescriptions, nutrition counseling, and symptom monitoring showed significant gains in sexual activity scores, though without a significant effect on overall sexual activity [33]. A 10-week tablet-based group CBSM intervention produced short-term improvements in sexual function [20]. The TrueNTH Sexual Recovery Program increased engagement in nonpenetrative sexual activities but did not significantly enhance overall sexual function or satisfaction with sex life [40]. Patients using the Interaktor app during and after radiotherapy reported significant increases in sexual activity in both intervention and control groups, with no differences between groups [36]. Similarly, the web-based PROGRESS program improved sexual function in both intervention and control groups [37].
Conversely, several digital and peer-led interventions reported no significant improvements or even declines in sexual function. The PC-PEP program showed no significant differences in sexual function compared with controls [29], and the ePATH digital rehabilitation tool integrating pelvic floor training and self-monitoring failed to demonstrate significant between-group differences in sexual function [39]. No significant differences in sexual function were found after the peer-led self-management intervention [22], the 12-week digital health coaching program [14], or the proactive health management program [24]. Sexual function declined and related problems increased following the nurse-led 12-week virtual care program [23]. Additionally, no significant changes in sexual function were observed following the 3-month telenursing intervention using tablet-based monitoring [35]. Overall, the evidence on the effectiveness of digital and self-management interventions on sexual function remained mixed, with many studies showings no significant improvements compared to standard care or control groups.

Sleep and Fatigue
Four studies reported sleep disturbance and/or fatigue outcomes, of which only one was a RCT [28] and three employed non-randomized or single-arm designs [23, 31, 36]. The Interaktor symptom monitoring app, used daily during radiotherapy with real-time clinician feedback, reduced both fatigue and insomnia [36], while a 6-week internet-delivered CBT program for insomnia significantly improved insomnia, sleep quality, and sleep efficiency. However, it produced no significant change in actigraph-measured sleep metrics [31]. Similarly, a 3-month multilevel web-based lifestyle program that included physical activity prescriptions and behavioral support produced modest but non-significant improvements in fatigue and sleep quality [28], whereas a 12-week nurse-led virtual survivorship program occasionally reported increased current fatigue scores and no significant change in insomnia scores despite other positive symptom outcomes [23].

QoL and Well-being
Twelve studies reported QoL and/or well-being, of which six were RCTs [21, 22, 26, 28, 33, 42] and six employed non-randomized or single-arm designs [14, 27, 34–36, 38]. The TEMPO program significantly improved overall QoL [26], and mobile internet–based continuing care yielded broad QoL gains [34]. Similarly, telenursing interventions enhanced physical, emotional, and functional well-being during recovery, although changes in social/family well-being were not significant [35]. Moreover, the Interaktor app improved emotional functioning compared with standard care [36]. Likewise, a peer-led self-management program involving educational materials and monthly telephone-based group support for six months improved QoL but showed no significant effect on disease-specific QoL compared with usual care [22]. Additionally, a 12-week IoT-based smart after-care program improved QoL in the intervention group; however, the control group receiving face-to-face education also showed an increase in QoL [33]. In a related study comparing online and in-person ADT education, side effect bother significantly decreased in both groups [38]. Furthermore, a 10-week web-based CBSM versus a health promotion intervention significantly improved functional well-being but had no significant effects on overall QoL [42].
By contrast, a 3-month multilevel web-based lifestyle program produced no significant changes in overall QoL [28]. Similarly, eight weekly MBCT sessions delivered via teleconference did not produce significant improvements in QoL or benefit finding compared to usual care [21]. In addition, a 5-week web-based chat group program showed no significant differences in QoL compared to the control group [27]. Furthermore, a 12-week digital health coaching program showed no significant change in overall general health [14].

Psychological outcomes and coping
Twelve studies reported psychological outcomes and/or coping strategies, of which nine were RCTs [20–22, 24–26, 37, 41, 42] and three employed non-randomized or single-arm designs [23, 27, 34]. A 6-month PC-PEP program reduced distress and improved functional well-being when introduced early in survivorship [25], while CBSM interventions decreased distress and improved depressive symptoms in men with advanced PCa [20, 42]. Additionally, a 10-week web-based dyadic self-management program significantly improved dyadic coping and adjustment and reduced depression, although anxiety and stress showed no significant change [26]. Similarly, a 6-month mobile internet–based care program reduced depression and anxiety [34], and the PROGRESS web-based survivorship tool enhanced adaptive coping strategies, including increased use of diversion coping and mitigation of declines in interpersonal coping, despite some reductions in marital interaction [37]. Moreover, a 12-week nurse-led virtual care program significantly reduced distress related to uncertainty about the future and work [23], and an online psychological intervention combined with a peer discussion forum significantly improved psychological distress [41].
In contrast, a 3-month proactive health management program significantly reduced anxiety and depression levels over time, although no significant differences were found between intervention and control groups [24]. Likewise, an 8-week teleconference-based MBCT program showed no significant effect on psychological distress, cancer-specific distress, or prostate-specific antigen (PSA) anxiety [21]. Furthermore, a 5-week web-based chat group intervention led to significantly higher anger levels but showed no significant effects on distress, anxiety, depression, need for help, PCa-specific anxiety, or coping compared to usual care [27], and a peer-led self-management intervention showed no significant difference between groups in psychological distress [22].

Self-Efficacy and Self-Care capacity
Six studies reported self-efficacy and/or self-care capacity outcomes, of which three were RCTs [24, 26, 42] and three employed non-randomized or single-arm designs [14, 34, 38]. Self-efficacy was a key intermediate outcome in several interventions, as mobile internet–based continuing care combining weekly video education, interactive symptom tracking, and clinician feedback over a 3-month period improved self-care capacity [34], while a 3-month WeChat-based proactive health management program with weekly nurse phone follow-ups enhanced participants’ self-care ability, self-efficacy, and readiness for discharge [24]. Similarly, a 12-week digital health coaching program showed significant improvement in self-efficacy [14], and a 10-week web-based dyadic self-management program significantly improved physical activity self-efficacy and self-management [26]. Moreover, a 10-week web-based CBSM intervention, compared with a health promotion program, significantly improved relaxation self-efficacy [42], and the ADT educational program, delivered as a single 1.5-hour online class with supplementary printed resources, produced self-efficacy gains comparable to its in-person format [38].

Physical activity and functional outcomes
Six studies reported physical activity levels and/or functional outcomes, of which five were RCTs [22, 26, 30, 33, 39] and one employed a single arm design [31]. Digital interventions that included structured exercise or lifestyle components generally produced measurable improvements in physical activity levels and related behaviors, as a 6-month peer-led self-management program combining monthly telephone group support with mailed educational materials led to greater resistance exercise in the intervention group at 3 and 6 months, with more men achieving physical activity targets at 3 months. However, no between-group differences were observed for aerobic activity at any time point or for resistance exercise at 12 months [22]. Similarly, an internet of things (IoT)-enabled 12-week lifestyle program integrating exercise prescriptions, dietary guidance, and remote symptom monitoring improved both physical activity participation and functional fitness indicators [33], while a 10-week web-based dyadic self-management program significantly improved physical activity plan and physical activity intention but had no significant effect on physical activity level [26]. Moreover, mobile health coaching programs that included personalized activity plans and self-care resources were associated with positive changes in healthy lifestyle behaviors, reductions in metabolic components such as fasting blood sugar and abdominal circumference, and improvements in body composition including body weight and body mass index (BMI) [30].
In contrast, a 4-week tele-CBT program for insomnia showed no effect on moderate to vigorous activity [31], and the ePATH intervention, a web-based and mobile self-care support system, did not produce statistically significant differences in pelvic floor muscle exercises or physical activity compared to standard care over the intervention period [39].

Education and knowledge outcomes
Some digital programs aimed to enhance patient knowledge about PCa, treatment side effects, and self-management strategies. For example, the RCT evaluating the TEMPO program, a 10-week interactive dyadic self-management platform, showed increased health literacy in certain domains [26], whereas the non-randomized mobile internet–based continuing care program (3 months) improved patients’ understanding of disease progression and self-care knowledge [34].
Table 3 presents the outcome measures used across studies and synthesizes the key findings for each survivorship domain. In addition, Table 4 provides a concise summary of the effectiveness of digital interactive interventions across survivorship outcome domains. It reports the total number of studies and the proportion of RCTs versus other designs, the number and percentage of studies that reported any beneficial effect, and an overall direction-of-effect judgment that gives primary weight to higher-quality evidence.

Discussion
This systematic narrative review synthesized evidence from 24 studies conducted across diverse international contexts, investigating the impact of digital interactive interventions on various aspects of symptom management and survivorship outcomes among PCa survivors. Overall, the findings highlight that digital interventions represent often effective strategies to address the complex and multidimensional needs of this population. However, the evidence base remains heterogeneous, with notable variability in outcomes, intervention designs, and methodological rigor.
One of the most consistent findings across literature was the improvement of urinary symptoms, particularly continence and irritative complaints, in patients exposed to digitally mediated interventions. This is perhaps unsurprising, as urinary dysfunction is one of the most common sequelae of PCa treatment and lends itself well to behaviorally focused interventions, such as pelvic floor training, lifestyle modifications, and self-monitoring delivered digitally [9, 44, 45]. Daily symptom tracking and timely feedback, as implemented in several mobile health applications and telenursing programs, may have provided survivors with actionable insights and continuous reinforcement [10]. The integration of digital reminders and personalized coaching likely enhanced adherence to pelvic floor exercises and lifestyle advice, thereby facilitating recovery [46].
In contrast, sexual functioning showed far less consistent benefits. Sexual function remains a core component of survivorship QoL in PCa patients [47]. While some interventions tailored specifically toward sexual rehabilitation reported modest improvements in sexual activity or satisfaction, most found no significant changes. This inconsistency may be explained by the multifactorial nature of sexual health, which is influenced not only by physical recovery but also by psychological, relational, and cultural factors [48]. Digital tools that focus primarily on education or self-monitoring may be insufficient to address deeper relational dynamics, body image concerns, or the need for intimate partner involvement [49, 50]. Moreover, sexual rehabilitation often requires nuanced, individualized care and sensitive communication that may not be fully replicable in digital formats [51]. These findings suggest that hybrid models integrating digital self-management with personalized counseling may be more effective.
Hormonal symptoms showed similarly inconsistent outcomes across interventions, with some studies reporting reductions in hot flashes and improvements in hormonal domains, while others demonstrated no meaningful changes or even worsening of symptoms. These mixed findings may be partly explained by the inherent variability and unpredictability of side effects associated with ADT [52], which can obscure the modest improvements achievable through digital lifestyle or cognitive-behavioral strategies. Furthermore, the heterogeneity of intervention protocols and outcome measures complicates interpretation, as some programs prioritized general symptom management rather than specifically addressing hormonal disturbances. In parallel, bowel outcomes, although less frequently assessed, revealed occasional improvements, particularly in interventions that incorporated structured symptom monitoring, daily self-reporting, and proactive clinician feedback. Such approaches appeared to facilitate early detection and timely self-care guidance [53, 54], thereby reducing the burden of gastrointestinal complaints in some patients. However, the evidence base in this domain remains sparse, and most interventions either failed to capture bowel-specific metrics or reported nonsignificant changes over time. Together, these findings highlight that while digital interventions hold promise for managing hormonal and bowel-related complications, current evidence is insufficient and underscores the pressing need for more targeted, standardized research in these areas.
QoL and psychological well-being represent interdependent dimensions of survivorship, and the evidence suggests that their improvement is most likely when interventions adopt a holistic and multi-component design. Programs that integrated physical activity, stress reduction, dietary guidance, and psychosocial support appeared to foster more sustainable gains, reinforcing broader survivorship research that highlights the necessity of comprehensive care rather than isolated strategies [55, 56]. At the psychological level, interventions grounded in various methods showed promise in alleviating distress and depressive symptoms, yet their variable efficacy particularly in relation to anxiety and depression points to the need for tailoring content to the diverse contexts and expectations of PCa survivors. Digital delivery offers important opportunities for accessibility, flexibility, and stigma reduction, but the absence of strong interpersonal connection in some technology-only formats may constrain engagement and limit depth of impact [57, 58]. Importantly, the relational nature of survivorship emerged as a key theme, as dyadic approaches that engaged partners or caregivers often enhanced coping and adjustment more effectively than individual-focused models. This suggests that future digital interventions should move beyond solitary self-management frameworks and embrace relational dynamics to more fully support the emotional and functional recovery of survivors [59].
Across diverse intervention formats, self-efficacy consistently emerged as one of the most reliably improved outcomes, underscoring its role as a cornerstone of survivorship care. This aligns closely with behavioral science theories, particularly Bandura’s social cognitive framework, which positions self-efficacy as a central determinant of motivation, persistence, and long-term adherence to health-promoting behaviors [60]. Digital programs that offered interactive feedback, personalized goal-setting, and real-time progress tracking seemed especially effective in cultivating a sense of confidence and competence in managing the multifaceted challenges of survivorship [61, 62]. These findings suggest that digital interventions may serve as powerful vehicles for skill-building and empowerment, uniquely suited to equip survivors with the tools for self-management [62, 63]. Yet, questions remain regarding the durability of these effects; few studies extended follow-up beyond the active intervention phase, leaving it unclear whether short-term gains in self-efficacy translate into enduring behavioral change. This gap highlights the need for longer-term evaluations to determine whether digital interventions foster sustained empowerment or whether booster sessions and continued engagement strategies are necessary to maintain momentum over time.
Digital interventions targeting physical activity have shown encouraging potential, though the overall evidence highlights variability in outcomes. Programs designed to promote exercise engagement whether through peer support, structured online prescriptions, or the use of wearable devices generally facilitated increases in movement and strength, yet consistent improvements across all forms of exercise, particularly aerobic activity, were less evident. These mixed results underscore the broader challenge of sustaining regular physical activity in cancer survivorship, where factors such as age, treatment side effects, and comorbid health conditions can limit participation [64, 65]. Importantly, the integration of digital tools appears to offer unique advantages by enabling ongoing monitoring, feedback, and motivation, all of which are central to sustaining long-term behavioral change [16, 66]. At the same time, the reliance on technology raises critical equity concerns, as not all survivors have the resources, access, or digital literacy required to fully benefit from these innovations [67, 68]. Digital exercise interventions show strong promise in supporting healthier lifestyles after PCa, but future work needs to focus on ensuring accessibility, tailoring to individual needs, and promoting sustained engagement across diverse survivor populations.
Sleep and fatigue outcomes demonstrate both potential and limitations of digital interventions. Tele-CBT and symptom monitoring apps often improved self-reported insomnia and fatigue, yet objective measures such as actigraphy showed little change, highlighting the difficulty of capturing sleep quality and the influence of expectancy effects. Similarly, fatigue benefits were typically modest, likely due to short intervention duration or limited exercise intensity. These findings suggest that while digital approaches can reduce psychological burden and enhance coping [69], sustainable improvements may require integration with structured exercise and broader lifestyle programs [70, 71]. At the same time, digital interventions consistently enhanced patient knowledge and health literacy, particularly regarding treatment side effects, self-care strategies, and disease progression. These gains in understanding can empower survivors by supporting informed decision-making and strengthening their sense of control during recovery [72, 73]. However, knowledge enhancement alone did not always translate into tangible behavioral change or symptom relief [74], highlighting a persistent gap between awareness and action. Addressing this gap requires embedding behavior change techniques such as motivational interviewing, commitment strategies, or peer accountability within digital programs to ensure that improved knowledge leads to lasting improvements in health and well-being [75, 76].
Analysis of the interventions demonstrating the strongest and most consistent benefits across urinary, psychological, self-efficacy, and QoL domains revealed several common active ingredients. Effective programs were typically multi-component and lasted at least 10–12 weeks with ongoing access or booster elements [24–26, 29, 30]. Personalization or tailoring based on symptom profile, treatment type, or individual goals was a hallmark of the most successful interventions [26, 34, 35, 39]. The inclusion of human support whether through nurse-led monitoring and feedback [34–36], health coaching calls [14], moderated peer forums [41], or dyadic involvement of partners [26] consistently enhanced engagement and outcomes compared to purely automated platforms. These findings suggest that the efficacy of digital interventions in PCa survivorship is driven primarily by behavioural support mechanisms, sustained engagement, and human-facilitated accountability rather than information provision alone.
Through the included studies, digital interventions varied considerably in their theoretical foundations and mechanisms of action. Several programs such as PC-PEP, ePATH, TEMPO, PROGRESS were explicitly designed to enhance self-management, autonomy, and self-empowerment through education, goal-setting, self-monitoring, and behavioural skill-building. In contrast, other interventions including MBCT, CBT-I, web-based CBSM adopted structured psychotherapeutic approaches aimed at reducing distress and improving emotional well-being. Many interventions combined elements of both approaches, creating hybrid models that supported empowerment, while also providing therapeutic guidance. This diversity reflects the evolving landscape of digital survivorship care rather than a uniform conceptual orientation. However, given this diversity, it remains challenging to determine the extent to which observed benefits reflect true self-empowerment effects versus broader supportive or therapeutic influences.

Clinical and practical implications
The current evidence suggests important practical recommendations. First, digital interventions should be multi-component, combining psychoeducation, guided pelvic-floor muscle training, cognitive-behavioral strategies, goal setting, and lifestyle advice programs such as PC-PEP, TEMPO, and TrueNTH Sexual Recovery that meet these criteria consistently produced the largest benefits in urinary function, QoL, psychological well-being, and self-efficacy. Second, personalization based on symptom profile, treatment type, or individual goals, together with integration of human support including nurse-led monitoring, coaching calls, moderated peer forums, or dyadic partner involvement, is essential for engagement and sustained outcomes, whereas fully automated, non-tailored, or short-duration tools yielded minimal or no benefit, particularly for sexual and hormonal symptoms. Healthcare providers can therefore confidently recommend established multi-component platforms as effective adjuncts to standard care for urinary, psychological, and self-management support, but for sexual recovery and hormonal/bowel symptoms, current digital tools provide only modest or inconsistent benefits and should be combined with face-to-face rehabilitation, couples counselling, or specialist referral. Third, equity and accessibility must be prioritized through low-bandwidth options, simple interfaces, multilingual content, and training support to ensure older adults, rural patients, and those with lower digital literacy are not excluded. Finally, while the primary focus of this review is survivorship care, recent advances in digital and artificial intelligence applications for multiparametric interpretation and pathological evaluation are also improving diagnostic accuracy and risk stratification upstream, which may ultimately facilitate more personalized survivorship planning [77].

Limitations
This review benefits from a comprehensive systematic search across six databases without date restrictions and transparent reporting according to PRISMA guidelines. However, some limitations should be acknowledged. Substantial clinical and methodological heterogeneity across populations, intervention types, comparators, and outcome measures precluded a meta-analysis, necessitating a narrative synthesis. Although 15 studies were randomized trials, all were rated as having ‘some concerns,’ several non-randomized studies were judged at moderate risk, and one study was at serious risk of bias. Sample sizes were frequently small, follow-up periods were generally short (≤ 12 months), and most trials were conducted in high-income countries with limited representation of culturally diverse or low-resource populations. A key limitation is the absence of data on oncological outcomes such as overall survival, cancer-specific survival, progression-free survival, or treatment-related mortality, reflecting the current focus of digital intervention trials on symptom management and QoL rather than survival endpoints.
Importantly, none of the included studies directly compared digital interventions with established in-person or traditional survivorship programs, and usual care was the most common comparator. Therefore, it is not currently possible to determine whether digital interventions are superior, equivalent, or inferior to traditional models of survivorship care. Together, these factors along with the narrative nature of the synthesis limit the strength and generalizability of the conclusions, particularly regarding long-term efficacy and effects on sexual function, hormonal symptoms, bowel outcomes, and survival.

Conclusion
This review indicates that digital interactive interventions offer meaningful opportunities to improve symptom management, QoL, psychological well-being, and self-efficacy, self-care capacity, and physical activity among PCa survivors, yet the evidence remains mixed across domains due to heterogeneity in design, delivery, and outcomes. Rather than being treated as standalone solutions, these tools should be integrated into broader, patient-centered survivorship care models. Future research should employ larger, methodologically rigorous RCTs with long-term follow-up, standardized outcome measures, and stratification of survivors by treatment modality particularly distinguishing ADT recipients from those treated with localized therapies to enable more homogeneous samples and clearer interpretation of digital intervention effects. Implementation science perspectives are also essential to assess cost-effectiveness, scalability, and integration within routine care, while addressing barriers of access for older adults, socioeconomically disadvantaged groups, and men with limited digital literacy. Co-design strategies that engage patients, partners, and clinicians may strengthen usability and clinical relevance, and multimodal approaches that combine digital platforms with pharmacological, psychological, or couple-based interventions may better address persistent issues such as sexual dysfunction, fatigue, and hormonal symptoms. By prioritizing rigor, inclusiveness, and translational relevance, future digital interventions can move beyond pilot testing toward suitable models that substantially transform PCa survivorship care.

Supplementary Information