Data was based on 1,075 complete questionnaires (Figure 1). Participants’ demographics are in Table 1, with NZ European men making up 74.60% and Māori men 16.19% due to oversampling. Most participants are married (71.04%) and living with spouses (77.11%). A high retirement rate is noted at 67.07%. Educationally, 48.70% have a high school diploma and 42.50% have a university education. Economically, 45.27% report a household income between $30k and $100k. Smoking prevalence is low at 8.73%. Approximately 48.83% report no chronic medical conditions. Common health issues include diabetes (13.77%), heart-related ailments (13.76%), circulation problems (14.51%), asthma or emphysema (15.81%), and stomach ulcers or IBS (10.42%). Māori men report significantly higher rates of alcoholism (15.22% vs 3.25%), diabetes (36.41% vs 9.09%), circulation problems (26.63% vs 12.01%), and major depression (11.96% vs 4.15%) compared to non-Māori. Radical prostatectomy is the most common treatment (42.88%), followed by external beam radiation therapy (27.81%), watchful waiting (18.70%), and ADT (17.12%). Other treatments include radioactive seed implantation (6.70%) and orchiectomy (1.95%).
Table 2 shows the comparisons between Māori and non-Māori men across all measured domains. Specifically, in the QoL-related scores, physical and mental health scores for Māori were significantly lower than those for non-Māori (Physical health: d = -0.32, p < 0.001; Mental health: d = -0.92, p < 0.001). EPIC-26 scores across domains such as urinary incontinence, bowel, and sexual functioning indicated greater adverse impacts on Māori (e.g., urinary incontinence: d = -0.48, p < 0.001; bowel: d = -0.82, p < 0.001). Furthermore, care service utilization scores also demonstrated a significantly lower care utilization among Māori (26.20) compared to non-Māori (41.84) (d = -0.79, p < 0.001). Notably, the overall supportive care needs measured by the SCNS were also significantly different, with Māori men having higher SCN (d = 0.97, p < 0.001).
Table 3 presents the results of the regression analysis of QoL domains and supportive care needs of non-Māori patients. According to the basic model, poorer mental health conditions (β = -8.50, P < 0.001, CI -11.37 to -5.63) are associated with an increased risk of higher SCN. Additionally, patients experiencing urinary incontinence (β = -3.07, P = 0.057, CI -6.24 to 0.10), urinary obstructive symptoms (β = -4.60, P = 0.006, CI -7.83 to -1.36), bowel issues (β = -4.11, P = 0.007, CI -7.08 to -1.15), and hormonal issues (β = -4.68, P = 0.000, CI -7.35 to -2.12) tend to have SCN.
In the adjusted model, the association between lower physical health and SCN becomes significant (β = -4.23, P = 0.014, CI -7.59 to -0.87). Mental health conditions continue to show a strong significant effect (β = -5.09, P = 0.003, CI -8.38 to -1.80). The impact of urinary incontinence becomes more pronounced (β = -5.53, P = 0.001, CI -8.80 to -2.26), while urinary obstructive and bowel symptoms lose significance. Hormonal issues, however, remain highly significant (β = -8.69, P < 0.001, CI -11.75 to -5.63).
In the interaction model, the inclusion of interaction terms reveals significant effects on the associations between several QoL domains and SCN. For mental health, the interaction with ADT (β_int = -4.27, P = 0.003, CI -7.11 to -1.42) indicates that ADT treatment exacerbates the negative association between poorer mental health and SCN. Patients undergoing ADT experience a further increase in SCN when their mental health is poor. For bowel issues, interactions with watchful waiting (β_int = -4.04, P = 0.008, CI -7.04 to -1.05) and ADT (β_int = -2.80, P = 0.047, CI -5.67 to -0.08) indicate that these treatments exacerbate the negative association between bowel issues and SCN, further increasing SCN for patients experiencing bowel issues.
Table 4 presents the results for Māori patients and highlights several key parallels and distinctions compared to their non-Māori counterparts. In the basic model, poorer mental health (β = -8.50, P < 0.001, CI -11.37 to -5.63) and hormonal issues (β = -4.68, P < 0.001, CI -7.35 to -2.12) significantly predict higher SCN, mirroring patterns observed in non-Māori patients. Similarly, significant associations are noted for urinary obstructive symptoms (β = -4.60, P = 0.006, CI -7.83 to -1.36) and bowel issues (β = -4.11, P = 0.007, CI -7.08 to -1.15), consistent with non-Māori results.
In the adjusted model for Māori patients, the significance of mental health (β = -5.09, P = 0.003, CI -8.38 to -1.80) and hormonal issues (β = -8.69, P < 0.001, CI -11.75 to -5.63) remains. Physical health conditions, however, become significant (β = -4.23, P = 0.014, CI -7.59 to -0.87), which contrasts with the non-Māori results where physical health was not significant (β = -0.11, P = 0.831, CI -1.10 to 0.13). Additionally, more pronounced effects of urinary incontinence (β = -5.53, P = 0.001, CI -8.80 to -2.26) are observed in Māori patients, similar to the non-Māori findings where urinary incontinence was trending towards significance in the basic model (β = -0.83, P = 0.069, CI -1.72 to 0.07).
In the interaction model for Māori patients, service utilization slightly reduces needs associated with both physical health (β_int = 0.29, P = 0.046, CI 0.01 to 0.58) and mental health (β_int = 0.14, P = 0.033, CI 0.01 to 0.26). Additionally, radical prostatectomy also significantly mitigates the negative association between mental health and SCN (β_int= 6.36, P = 0.002, CI 2.32 to 10.41), as well as between hormonal issues and SCN (β_int = 3.69, P = 0.028, CI 1.12 to 7.52).