Expanded Prostate Cancer Index Composite (EPIC) | University of Michigan Medical School

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Expanded Prostate Cancer Index Composite (EPIC)

The Expanded Prostate Cancer Index Composite (EPIC) is a comprehensive instrument designed to evaluate patient function and bother after prostate cancer treatment.

Content from the original UCLA-Prostate Cancer Index (PCI) was expanded with guidance from a development cohort of localized prostate cancer patients and an expert panel comprised of urological oncologists, radiation oncologists (including brachytherapy expertise), survey researchers, and prostate cancer nurses.

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Overview

These experts, patients, and review of the literature suggested a need to augment the UCLA-PCI with items to capture additional concerns relevant to brachytherapy, external beam radiation, radical prostatectomy, and androgen deprivation. Accordingly, the UCLA-PCI was supplemented with specific items addressing irritative and obstructive voiding symptoms (the original UCLA-PCI had queried principally incontinence only in urinary function assessment), hematuria, additional bowel symptoms (to improve the suboptimal bowel function scale from the original UCLA-PCI), and hormonal symptoms.

Symptom-specific bother items corresponding to each symptom item were added to elicit multi-item bother scales for each HRQOL domain. Responses and comments from the development cohort were incorporated to derive the final instrument: the Expanded Prostate Cancer Index Composite (EPIC).

Initial work began when Dr. John Wei, as part of his fellowship, worked with Dr. Martin Sanda and Rodney Dunn to modify and expand the UCLA Prostate Cancer Index (PCI) to create the Expanded Prostate Cancer Index Composite (EPIC). EPIC is now the preeminent tool used worldwide to measure health-related outcomes for men with localized prostate cancer, having been translated into at least 13 other languages or dialects in addition to English.

Epic Instruments

*This instrument can be added on to the end of any of the other EPIC instruments to collect demographic information.

Peer-reviewed Articles

Scoring Utilities

* Choose the 'Save to Disk' option after clicking on the SAS Macro name. If your browser displays the macro on the screen as a text file, choose File -> Save As, and then choose a location to save the macro.

Minimally Important Differences for EPIC-26

EPIC-26 Domain	Minimally Important Difference (EPIC-26 Points)*
Urinary incontinence	6-9
Urinary irritative/obstructive	5-7
Bowel	4-6
Sexual	10-12
Vitality/hormonal	4-6

* Based on pooled averages from distribution- and anchor-based approaches.

Sample Size

Number of EPIC Domains as Primary Endpoints	Domain-Specific Significance Level (For Overall Significance of 5%)	Potential Endpoints	Required Sample Size Per Treatment Group (Based on Effect Size of 0.5)
			80% Power	90% Power
1	0.05	Any 1 of the summary scores - Urinary, Bowel, Sexual, Hormonal	64	86
4	0.0125	Urinary, Bowel, Sexual, and Hormonal Summary Scores	91	116
5	0.01	Urinary Irritative, Urinary Incontinence, Bowel, Sexual, and Hormonal Summary Scores	96	121
6	0.0083	Urinary Irritative, Urinary Incontinence, Bowel, Sexual, and Hormonal Summary Scores and SF-12 PCS	99	125
10	0.005	Urinary Irritative, Urinary Incontinence, and Function and Bother subscales for Urinary, Bowel, Sexual, and Hormonal Domains	109	136
12	0.0042	Urinary Irritative, Urinary Incontinence, Function and Bother subscales for Urinary, Bowel, Sexual, and Hormonal Domains, and SF-12 PCS and MCS Scores	112	140

If less than 100% response rate is anticipated, then sample sizes will need to be adjusted. For example, an expected 75% response rate at 2 years for a study with a single endpoint and 80% power would require 86 subjects (64/0.75 = 85.33).

Quality of Life Comparison in Prostate Treatments

Control-based Norms & Other Statistics

Explore the EPIC domain-specific scores for 112 non-cancer controls, including mean scores, standard deviations, and percentages at minimum and maximum levels.

Validation of EPIC-26

Discover Marty Sanda's comparison of quality of life outcomes for different prostate cancer treatments: brachytherapy, RT, & RP. This analysis includes data on urinary incontinence and reliability scores from February 3, 2004.

Epic Translations

In the years since EPIC was released, independent investigators around the world have translated EPIC versions into several different languages and dialects using rigorous methods. While the original EPIC developers did not participate in these efforts, we are very supportive of this work and grateful that the results will allow EPIC to be used in even more populations around the globe. To both recognize these efforts and to facilitate the discovery and use of these translations, we are providing the translation repository at the link below. If you are an investigator who has translated EPIC into a non-US English language or dialect and want to get your work added to the repository, please contact Rod Dunn at [email protected].

View EPIC Translation Repository

Frequently Asked Questions

EPIC stands for the Expanded Prostate Cancer Index Composite.

EPIC is a comprehensive instrument designed to evaluate patient function and bother after prostate cancer treatment.

Yes, you are free to make copies and distribute EPIC.

No, there is no fee required to use EPIC.

Yes, please go to EPIC Translation Repository for non-English versions of EPIC.

For any manuscript published that uses EPIC, you should reference the EPIC validation paper published in the December 2000 issue of Urology.

Wei J, Dunn R, Litwin M, Sandler H, and Sanda M. "Development and Validation of the Expanded Prostate Cancer Index Composite (EPIC) for Comprehensive Assessment of Health-Related Quality of Life in Men with Prostate Cancer", Urology. 56: 899-905, 2000.

Researchers