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Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP)
Please answer the following questions by choosing the appropriate options. All questions are about your health and symptoms in the LAST FOUR WEEKS.
1. Overall, how much of a problem has your urinary function been for you?
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
2. Which of the following best describes your urinary control?
--Select--
--Select--
Total control
Total control
Occasional dribbling
Occasional dribbling
Frequent dribbling
Frequent dribbling
No urinary control
No urinary control
3. How many pads or adult diapers per day have you been using for urinary leakage?
--Select--
--Select--
None
None
One pad per day
One pad per day
Two pads per day
Two pads per day
Three or more pads per day
Three or more pads per day
4. How big a problem, if any, has urinary dripping or leakage been for you?
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
5. How big a problem, if any, has each of the following been for you?
a. Pain or burning with urination
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
b. Weak urine stream/ incomplete bladder emptying
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
c. Need to urinate frequently
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
6. How big a problem, if any, has each of the following been for you?
a. Rectal pain or urgency of bowel movements
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
b. Increased frequency of your bowel movements
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
c. Overall problems with your bowel habits
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
7. How would you rate your ability to reach orgasm (climax)?
--Select--
--Select--
Very good
Very good
Good
Good
Fair
Fair
Poor
Poor
Very poor to none
Very poor to none
8. How would you describe the usual quality of your erections?
--Select--
--Select--
Firm enough for intercourse
Firm enough for intercourse
Firm enough for masturbation and foreplay only
Firm enough for masturbation and foreplay only
Not firm enough for any sexual activity
Not firm enough for any sexual activity
None at all
None at all
9. Overall, how much of a problem has your sexual function or lack of sexual function been for you?
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
10. How big a problem, if any, has each of the following been for you?
a. Hot flashes or breast tenderness/ enlargement
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
b. Feeling depressed
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
c. Lack of energy
--Select--
--Select--
No problem
No problem
Very small problem
Very small problem
Small problem
Small problem
Moderate problem
Moderate problem
Big problem
Big problem
Check Score
Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP)
Your Symptoms Score:
Overall Prostate Cancer QOL Score is
0
/60
Panel enter code
Please enter the code provided to you and click Next
Next
--Select--
--Select--
I don't have a code
I don't have a code
Panel Done
Then you're done.
Thank you for using the EPIC-CP calculator.
Have a nice day!
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Panel submit
Please read carefully:
By entering your PID and submitting the form, you're consenting that the data related to your symptoms are being sent securely to the intended recipient's email.
Enter your PID then click Submit
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