Caution with Use of the EPIC-50 Urinary Bother Scale: How Voiding Dysfunction Modifies its Performance.

Area of Science:

• Urology
• Oncology
• Patient-Reported Outcomes

Background:

• Radical prostatectomy is a common treatment for prostate cancer.
• Urinary and sexual function are key quality of life domains affected by treatment.
• Understanding patient bother is crucial for managing treatment side effects.

Purpose of the Study:

• To evaluate the agreement between patient-reported urinary and sexual function and bother after radical prostatectomy.
• To identify potential modifiable mechanisms contributing to patient bother.
• To inform clinical assessment and patient counseling regarding post-prostatectomy outcomes.

Main Methods:

• Patients undergoing radical prostatectomy were recruited between 2011-2014.
• Urinary and sexual outcomes were assessed using the Expanded Prostate Cancer Index Composite-50 (EPIC-50) pre-operatively and at 5 weeks and 12 months post-operatively.
• Spearman rank correlation and agreement/disagreement analyses were employed.

Main Results:

• Moderate to good agreement was found between function and bother (urinary: r=0.51-0.69; sexual: r=0.65-0.80).
• Discordant groups, where bother did not align with function, were identified in both urinary and sexual domains.
• Splitting the urinary bother scale into incontinence and voiding dysfunction subscales significantly improved agreement (urinary function and incontinence bother: r=0.78-0.83).

Conclusions:

• The Expanded Prostate Cancer Index Composite-50 (EPIC-50) is a valuable tool for assessing post-prostatectomy outcomes.
• Investigators should consider stratifying urinary bother by incontinence and voiding dysfunction for more accurate assessment.
• This approach can prevent distortions in function-bother comparisons and improve understanding of patient experiences after radical prostatectomy.