Clinical Interpretation Of The Expanded Prostate Cancer Index Composite-Short Form Sexual Summary Score

Main Category: Prostate / Prostate Cancer
Also Included In: Sexual Health / STDs
Article Date: 30 Dec 2009 - 0:00 PST

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UroToday.com - In the December, 2009 online edition of the Journal of Urology, Dr. Jeffrey Wheat and colleagues from the University of Michigan utilize the Expanded Prostate Cancer Index Composite (EPIC) to evaluate sexual quality of life parameters.

EPIC is a validated HRQOL questionnaire that evaluates 4 functional areas that affect men after radical prostatectomy (RP) for prostate cancer (CaP); urinary, erectile, bowel and hormonal. A limitation of EPIC is that individual composite scores are difficult to interpret. The authors point out that the IIEF questionnaire and its 5-question short form IIEF-5 or SHIM are validated, domain specific instruments which categorize patients into 1 of 5 distinct and clinically meaningful erectile dysfunction (ED) severity groups. SHIM scores range from 1 to 25; severe level 1 (1 to 7), moderate level 2 (8 to 11), mild to moderate level 3 (12 to 16), mild level 4 (17 to 21), and no ED level 5 (22 to 25). The goal of this study was to identify scoring levels on the EPIC-short form (EPIC-S) that correspond with SHIM severity groups to provide a descriptive framework for interpreting EPIC-S scores.

Data from the EPIC-S and SHIM forms were derived form 561 patients treated with RP from 1995 to 2007. A validation cohort of 430 patients who completed the EPIC-long form was also used. Patients had regular follow-up with completion of subsequent questionnaires. Post-operative EPIC-S, SHIM and EPIC-bother scores were significantly lower than preoperative scores, but there was no difference between the two groups with respect to preoperative or postoperative EPIC-s scores. Statistical analysis using a scatterplot and modeling showed strong correlation between SHIM and EPIC-S. The investigators then assessed whether EPIC-S score levels represented distinct clinical groups; i.e. whether the degree of sexual bother was different among individual sex summary score levels. They found that EPIC-S score levels differentiated EPIC-bother scores. Factors associated with this were live-together status and patient age. After adjusting for age, pathologic stage, nerve sparing status, hormone treatment and marital status, there was a significant difference in EPIC-bother scores among the 5 EPIC-S score levels. This suggests that sexual bother scores are significantly different among the EPIC-S groups and represent discrete, clinically relevant cutoffs.

Wheat JC, Hedgepeth RC, He C, Zhang L, Wood DP Jr.
J Urol. 2009 Oct 16. Epub ahead of print.
doi:10.1016/j.juro.2009.08.088
Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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