Expanded Prostate Cancer Index Composite — Short Form (EPIC-26)
Patient Name: ____________________________ *Date:* ____________
Date of Birth: ____________ *Medical Record #:* ____________
Instructions: This questionnaire asks about your urinary, bowel, sexual, and hormonal function over the past 4 weeks. Please answer every question by circling the number that best describes your experience. There are no right or wrong answers.
SECTION 1: URINARY INCONTINENCE (Questions 1–4)
1. Over the past 4 weeks, how often have you leaked urine?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
2. Which of the following best describes your urinary control during the past 4 weeks?
| No Urinary Control Whatsoever | Frequent Dribbling | Occasional Dribbling | Total Control |
|---|---|---|---|
| 1 | 2 | 3 | 4 |
3. How many pads or adult diapers per day did you usually use to control leakage during the past 4 weeks?
| 3 or More Pads per Day | 1–2 Pads per Day | None |
|---|---|---|
| 1 | 2 | 3 |
4. How big a problem, if any, has dripping or leaking urine been for you during the past 4 weeks?
| No Problem | Very Small Problem | Small Problem | Moderate Problem | Big Problem |
|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 |
SECTION 2: URINARY IRRITATIVE/OBSTRUCTIVE (Questions 5–8)
5. Over the past 4 weeks, how often have you had pain or burning with urination?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
6. Over the past 4 weeks, how often have you had blood in your urine?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
7. Over the past 4 weeks, how often have you had a weak urine stream or incomplete emptying?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
8. Overall, how big a problem, if any, has your urinary function been for you during the past 4 weeks?
| No Problem | Very Small Problem | Small Problem | Moderate Problem | Big Problem |
|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 |
SECTION 3: BOWEL FUNCTION (Questions 9–14)
9. Over the past 4 weeks, how often have you had urgency to have a bowel movement?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
10. How often have you had uncontrolled leakage of stool during the past 4 weeks?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
11. How often have you had bloody stools during the past 4 weeks?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
12. How often have you had crampy pain in your abdomen, pelvis, or rectum during the past 4 weeks?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
13. How often have you had increased frequency of bowel movements during the past 4 weeks?
| Always | Usually | About Half the Time | Seldom | Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
14. Overall, how big a problem, if any, have your bowel habits been for you during the past 4 weeks?
| No Problem | Very Small Problem | Small Problem | Moderate Problem | Big Problem |
|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 |
SECTION 4: SEXUAL FUNCTION (Questions 15–20)
15. How would you rate your ability to have an erection during the past 4 weeks?
| Very Poor to None | Poor | Fair | Good | Very Good |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
16. How would you describe the usual quality of your erections during the past 4 weeks?
| None at All | Not Firm Enough for Any Sexual Activity | Firm Enough for Masturbation and Foreplay Only | Firm Enough for Intercourse |
|---|---|---|---|
| 1 | 2 | 3 | 4 |
17. How often have you had an erection when you wanted one during the past 4 weeks?
| Never | Less Than Half the Time | About Half the Time | More Than Half the Time | Whenever I Wanted |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
18. How would you rate your ability to reach orgasm (climax) during the past 4 weeks?
| Very Poor to None | Poor | Fair | Good | Very Good |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
19. How would you describe the usual quality of your orgasms during the past 4 weeks?
| None | Very Poor | Fair | Good | Very Good |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
20. Overall, how big a problem, if any, has your sexual function or lack of sexual function been for you during the past 4 weeks?
| No Problem | Very Small Problem | Small Problem | Moderate Problem | Big Problem |
|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 |
SECTION 5: HORMONAL FUNCTION (Questions 21–26)
21. Over the past 4 weeks, how often have you experienced hot flashes?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
22. Over the past 4 weeks, how often have you experienced breast tenderness or enlargement?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
23. Over the past 4 weeks, how often have you felt depressed?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
24. Over the past 4 weeks, how often have you felt a lack of energy?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
25. Over the past 4 weeks, how often have you experienced a change in body weight?
| More Than Once a Day | About Once a Day | More Than Once a Week | About Once a Week | Rarely or Never |
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 |
26. Overall, how big a problem, if any, have the above hormonal symptoms been for you during the past 4 weeks?
| No Problem | Very Small Problem | Small Problem | Moderate Problem | Big Problem |
|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 |
SCORING SUMMARY
| Domain | Questions | Score Range | Your Score |
|---|---|---|---|
| Urinary Incontinence | 1–4 | 0–16 | _______ |
| Urinary Irritative/Obstructive | 5–8 | 0–19 | _______ |
| Bowel Function | 9–14 | 0–24 | _______ |
| Sexual Function | 15–20 | 0–28 | _______ |
| Hormonal Function | 21–26 | 0–24 | _______ |
Note: Each domain is scored separately and converted to a 0–100 scale, where higher scores indicate better function. Your doctor or care team will calculate the converted scores.
HOW TO INTERPRET EPIC-26 SCORES
After conversion to the 0–100 scale:
- 90–100: Excellent function — minimal or no symptoms
- 70–89: Good function — mild symptoms
- 50–69: Moderate dysfunction — noticeable symptoms affecting quality of life
- Below 50: Significant dysfunction — symptoms substantially affect daily life
What is a meaningful change?
A change of 6–12 points on the 0–100 scale (depending on the domain) is generally considered clinically meaningful.
WHY THIS QUESTIONNAIRE MATTERS
The EPIC-26 is the most widely used quality-of-life tool specifically designed for prostate cancer patients. It captures the side effects that matter most to patients across all treatment types:
- Before treatment: Establishes your baseline function so your doctor can predict how treatment may affect you and track changes over time.
- During and after treatment: Helps your care team identify problems early and adjust your care.
- For research: Helps compare outcomes across different treatments so future patients benefit from better evidence.
The NCCN guidelines recommend measuring baseline function with a validated instrument such as EPIC-26 before starting any prostate cancer treatment.
TRACKING YOUR SCORES OVER TIME
| Date | Urinary Incontinence | Urinary Irritative | Bowel | Sexual | Hormonal | Notes |
|---|---|---|---|---|---|---|
| _____ | __ | Baseline (before treatment) | ||||
| _____ | __ | |||||
| _____ | __ | |||||
| _____ | __ | |||||
| _____ | __ |
Notes for your doctor: _______________________________________________