Post-Treatment Adverse Health Correlates among Prostate Cancer Survivors in a Sample of Men Residing in Atlantic Canada

Round 1

Reviewer 1 Report

It was a pleasure to review this paper and I congratulate the Authors for this scientific effort.

I can offer only some minor comments:

• the introduction is a bit too long, and I think it requires shortening and a better focusing to the aims of the study
• Methods: I feel that the sentence "Although the age range of the total sample of men was 35-69 (n=632), we narrowed our selection to include the age range of those who reported a lifetime history of cancer diagnosis (36-69)" is unclear. Can the Authors clarify? 
• Covariates: I am not sure that merging "divorced, widowed, separated, single, or never married" in one single group really makes sense, there may be some differences in anxiety/depression between a recently-divorced man and a confirmed bachelor. Can the Authors comment on this?
• Do the Authors think that the findings of the study can apply also to cultures other than Canadian (Western), e.g. far Eastern countries or Latin-America?

Author Response

Reviewer 1

It was a pleasure to review this paper and I congratulate the Authors for this scientific effort.

I can offer only some minor comments:

• the introduction is a bit too long, and I think it requires shortening and a better focusing to the aims of the study

RESPONSE TO THE REVIEWER. We thank the reviewer for these comments. We now have shorted and focused the introduction for clarity and specificity.

• Methods: I feel that the sentence "Although the age range of the total sample of men was 35-69 (n=632), we narrowed our selection to include the age range of those who reported a lifetime history of cancer diagnosis (36-69)" is unclear. Can the Authors clarify? 

RESPONSE TO THE REVIEWER. We thank the reviewer for pointing out this error. This is a typo on our end following multiple revisions. We now specify that the sample selection was based on 632 men (35-69 of age) who reported having had a history of cancer diagnosis.

• Covariates: I am not sure that merging "divorced, widowed, separated, single, or never married" in one single group really makes sense, there may be some differences in anxiety/depression between a recently-divorced man and a confirmed bachelor. Can the Authors comment on this?

RESPONSE TO THE REVIEWER. We thank the reviewer for this question. Coding for this variable was based on cell counts. Some were extremely small (<5) so to insure consistency in the model we had to reduce the categories to two. We now add a comment about this in the limitation section of our paper. Thank you for pointing this out. There could be such differences and future research should attempt to examine this possibility.

• Do the Authors think that the findings of the study can apply also to cultures other than Canadian (Western), e.g. far Eastern countries or Latin-America?

RESPONSE TO THE REVIEWER. We thank the reviewer for this question. This is an excellent question. The short answer is we don’t know. My speculation is that probably this is the case. But we really don’t know. We need data to examine this hypothesis. Our group has been involved in the analyses of Atlantic Canada, Maritimes Canada and national Canada databases examining this population but unfortunately the survey data we looked at, had little ethnic diversity. This is particularly an issue in Atlantic Canada where 96%, of people in the population are British and Irish and about 2% are of French descent, with the remaining 2% being made up of native peoples and other ethnic groups.

Reviewer 2 Report

This is a well conducted study and presented with sound introduction. Only few advices for the authors to polish it.
1. In the results of the abstract, "%" symbol was suggested to be added after each number for prevention from misunderstanding. 2. In the abstract, the authors indicated mainly the significance of depression in PCa survivors with surgery. But, the conclusion jumped too much about the need of multidisciplinary care plan and targeted program. The authors are suggested to rewrite both parts for balance.
3. Similar opinion as above in the main context, please the authors

introduce future application about intervention in the discussion section and conclude only with the focus of the findings.

Author Response

Reviewer 2

This is a well conducted study and presented with sound introduction. Only few advices for the authors to polish it. 

1. 
   In the results of the abstract, "%" symbol was suggested to be added after each number for prevention from misunderstanding.

RESPONSE TO THE REVIEWER. We thank the reviewer for these comments and this suggestion. We now add % after each percentage to improve clarity and prevent misunderstanding.

2. In the abstract, the authors indicated mainly the significance of depression in PCa survivors with surgery. But, the conclusion jumped too much about the need of multidisciplinary care plan and targeted program. The authors are suggested to rewrite both parts for balance. 

3. Similar opinion as above in the main context, please the authors

introduce future application about intervention in the discussion section and conclude only with the focus of the findings.

RESPONSE TO THE REVIEWER. We thank the reviewer for this suggestion. We have reviewed the discussion to account for a more narrow/specific focus on the depression results, explaining the lack of emerging anxiety symptoms, and how the need for multidisciplinary approaches to survivorship education and care plans fits in. Additional edits were also made in the introduction.