Early EPIC score for urinary and sexual function predicts recovery after prostatectomy

This study evaluated whether the EPIC questionnaire can predict urinary and sexual functions one year after surgical removal of the prostate (radical prostatectomy) in patients with prostate cancer.

Since the prostate gland is closely connected to the bowel, urinary tract and the nerves that control sexual function, local treatments for prostate cancer often cause side effects on these organs. A successful treatment is defined as postoperative cancer control (meaning the ability to maintain a disease free patient after surgery), with minimal or no side effects on urinary continence (control on urination) and erectile function. The Expanded Prostate Cancer Index Composite (EPIC) is a questionnaire used to evaluate bowel, urinary, sexual, and hormonal functions after treatment for prostate cancer. Usually, after a radical prostatectomy, urinary and sexual functions are impaired. Impaired functions have been shown to steadily recover over time in most men. However, an effective predictor of long-term impairment could be a useful tool in the management of prostate cancer, and could help evaluate whether certain patients require additional treatments. This study evaluated the usefulness of the EPIC scores 3 months after prostatectomy in predicting the functional outcomes 12 months after the surgery.

437 men diagnosed with prostate cancer were chosen for this study. All patients were treated with radical prostatectomy, either open or robotic (laparoscopic) surgery. Researchers evaluated patients’ urinary and sexual functions using the EPIC-UIN (EPIC Urinary Inventory) and EPIC-S (EPIC Sexual Inventory) questionnaires before surgery (at baseline), 3 months and 12 months after surgery. The researchers then calculated the possibility of recovery after 12 months, based on the 3 months scores.

Results showed that, when evaluating EPIC-UIN scores, only 2.7% of the patients showed worse urinary function after a year compared to the 3-months results, while 49.4% were stable (meaning no change in urinary function), and 47.8% showed improved results. For the EPIC-S evaluation, only 3.9% of patients showed worse sexual function one year after the surgery. 59.2% were stable and 36.9% showed improved results. Patients with good urinary function at 3 months based on EPIC-UIN score had an 8.73 times higher chance of returning to baseline function at 12 months, while patients with good sexual function at 3 months based on EPIC-S scores had only a 4.15 times higher chance of returning to baseline sexual function.

In summary, this study found that the EPIC scores after 3 months were useful tools in predicting urinary and sexual outcomes after a year from radical prostatectomy. The EPIC questionnaire was found to have an important role in providing reassurance for patients after surgery, and their ability to recover. Additionally, in certain cases, the EPIC scores may provide guidance for additional therapies for bladder control and/or impotence.

This study did not account for other factors that might have influenced urinary and sexual function, such as the degree of nerve preservation during surgery, which may significantly influence the results.

Consult with your physician on how to improve urinary and erectile function after surgery.