Development and Validation of Crosswalks for Patient-reported Sexual and Urinary Outcomes Between Commonly Used Instruments

Eur Urol. 2019 May;75(5):723-730. doi: 10.1016/j.eururo.2018.12.002. Epub 2018 Dec 17.


Background: Patient-reported outcome measures (PROMs) have become widely adopted in the care of patients with prostate cancer, but there is no validated crosswalk between two commonly used instruments, the Expanded Prostate Cancer Index Composite Short Form (EPIC-26) and the Memorial Sloan Kettering (MSK) instrument, which consists of the International Index of Erectile Function-6 (IIEF-6) questionnaire and the MSK radical prostatectomy urinary outcome scale.

Objective: To develop and validate bidirectional crosswalks between the sexual and urinary domains (single domain in MSK, separate incontinence and irritative/obstructive domains in EPIC-26) of the MSK and EPIC-26 instruments.

Design, setting, and participants: Radical prostatectomy (RP) patients completing instruments at MSK and Michigan Urological Surgery Improvement Collaborative (MUSIC) between January and May of 2017 were invited to enroll. Stratified random sampling (by institution, MSK urinary function score, and MSK erectile function score) was used to divide patient data into training and test sets. Models were developed to predict the domain score for each instrument using the other's item responses and domain scores. Performance was evaluated using capped root-mean-squared error and accuracy at established thresholds.

Results and limitations: We received 517 instruments at MSK and 1033 within MUSIC, which were assigned to training (825), post-RP test (412), and pre-RP test (313) sets. We found the crosswalks to have low error and high accuracy. Although the crosswalks are more accurate if responses to each item are known, it is possible to convert between instruments on the basis of a total domain score.

Conclusions: The crosswalks are a valid way to convert between sexual and urinary domains of the MSK and EPIC-26 instruments.

Patient summary: We developed and validated a set of formulas that allow conversion of sexual and urinary function scores between the Memorial Sloan Kettering and Expanded Prostate Cancer Index Composite Short Form patient-reported outcome questionnaires. These crosswalks allow seamless transition between the two questionnaires.

Keywords: Patient-reported outcomes; Sexual dysfunction; Urinary incontinence.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Erectile Dysfunction / drug therapy*
  • Humans
  • Lower Urinary Tract Symptoms / etiology
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures*
  • Postoperative Period
  • Preoperative Period
  • Prostatectomy / adverse effects
  • Prostatic Neoplasms / complications
  • Prostatic Neoplasms / surgery*
  • Urinary Incontinence / etiology*
  • Urological Agents / therapeutic use


  • Urological Agents