International Prostate Symptom Score (I-PSS)

Prostate cancer and benign prostatic hyperplasia (BPH) are common in adult men and are both slow-progressing diseases that deserve careful evaluation and follow-up,

When a doctor makes a diagnosis about your prostate, he will mention a few things. The International Prostate Symptom Score (IPSS) may be one of them.

What is the International Prostate Symptom Score?

As the name implies, the International Prostate Symptom Score is a scoring system. It is based on eight simple questions a doctor will ask (1). It can be self-administered by patients, as well. Thus, it is a valuable tool to diagnose and treat prostate problems.

This tool is useful to diagnose urinary tract symptoms due to bladder outlet obstruction in men. It is also beneficial to know how effective your treatment is.

The IPSS will give your doctor enough data to know whether he needs to change your prostate medication. He may also try new methods to improve your quality of life. It may even guide and predict the outcome of transurethral resection of the prostate (2)

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How was the IPSS developed?

Prostate volume has always been an important marker. The American Urological Association developed this questionnaire, trying to reduce medical error (3). It formerly had seven questions, but an eight-question was added to assess the patient’s quality of life (1).

The resulting IPSS test is a questionnaire of eight questions. You should give each item a number on a scale from one to five. Zero means never, and five means almost always. After receiving your answers, your doctor will score your test. Then, he will give you his medical opinion.

You’re done filling all of the questions using a scoring system from zero to five. Then, your IPSS is calculated by adding the numbers and studying your case. You will get a 0 to 35 number and compare it with a score table.

What is a healthy IPSS?

You added your numbers and got your total score. Now, you can be diagnosed with mild, moderate, or severe urinary tract symptoms.

A prostate symptom score of 0 means you have no symptoms at all, but having a low score (1 to 7) means you have mild symptoms. These are usually caused by benign prostatic hyperplasia (BPH), a common condition in older adults (1).

Starting from a score of 8, you will be diagnosed with moderate urinary tract symptoms. Based on clinical trials, we know that 20 or more accounts for severe prostate problems. They are usually associated with a significant increase in prostate volume (1).

So, in short, your results should be interpreted as follows:

  • 0-8: mild or no symptoms
  • 8-19: moderate symptoms
  • 20-35: severe symptoms

What factors are considered when determining IPSS?

The questions in an IPSS test will evaluate the following factors (1, 3):

  • The sensation of not emptying your bladder after urinating
  • A higher frequency of urination
  • Intermittent urination
  • Urgency to urinate
  • Weak urinary stream
  • Straining to urinate
  • Waking up at night to urinate (nocturia)
  • Self-assessment of your quality of life

Symptoms of prostate enlargement

There are many symptoms of prostate enlargement. However, all of them are associated with bladder function and the urinary tract. Thus, they are called lower urinary tract symptoms or LUTS.

Benign prostatic hyperplasia or BPH symptoms are usually as follows (4):

  • Urgency to urinate and higher frequency of urination. This is often due to irritation of the bladder. It should be differentiated from urinary tract infections.

  • Waking up at night to urinate several times, usually affecting sleep.

  • Slow or weak urinary stream, one of the most important symptoms of BPH.

  • Hesitancy (not being able to start) and intermittency (continuously starting and stopping) of the urinary stream.

  • Terminal dribble and post-micturition dribble.

What are the leading causes of prostate enlargement?

When we have these symptoms, we should proceed to other tests. If we can see an enlarged prostate in an ultrasound, there are many potential causes (5):

  • Benign prostatic hyperplasia: It is the most common cause of prostate enlargement. Even though it is an alteration of the prostate tissue, it is not dangerous.

  • Prostatitis: Urinary infections or sexually-transmitted diseases may cause it. It usually increases the volume of the prostate, too.

  • Tumors and prostate cancer: This is a dangerous alteration of the prostate tissue. Prostate cancer has a slow progression compared to other cancers. But still, it is imperative to evaluate your condition.

How dangerous is an enlarged prostate?

If you have urinary symptoms, it is essential to understand what prostate problems are causing them. It may be BPH, and you will be fine. But if you have prostate cancer, you will need a medical opinion and follow-ups to make sure you’re out of danger.

Even prostate cancer may be relatively benign because it progresses very slowly. But still, there are exceptions to this, and you don’t want to accept unnecessary risks.

Best supplements for treating an enlarged prostate

The best supplements for treating enlarged prostate symptoms are:

Supplements that contain these ingredients are likely to improve bladder function and urinary symptoms.

Still, if you have prostate problems, ask your doctor and make your treatment choices along with him. Make sure you’re buying a real product. One that improved urinary tract symptoms in other men with prostate enlargement.


Make a well-informed choice. Do not neglect your symptoms. If you follow these tips along with your medical advice, you will be over your prostate problems and regain your health naturally.


  1. Rees, J., Bultitude, M., & Challacombe, B. (2014). The management of lower urinary tract symptoms in men. Bmj, 348, g3861.
  2. Hakenberg, O. W., Pinnock, C. B., & Marshall, V. R. (1997). Does evaluation with the International Prostate Symptom Score predict the outcome of transurethral resection of the prostate?. The Journal of urology, 158(1), 94-99.
  3. Barry, M. J., Fowler, F. J., O’Leary, M. P., Bruskewitz, R. C., Holtgrewe, H. L., Mebust, W. K., … & Measurement Committee of the American Urological Association*. (1992). The American Urological Association symptom index for benign prostatic hyperplasia. The Journal of urology, 148(5 Part 1), 1549-1557.
  4. Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., … & Wein, A. (2002). The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub‐committee of the International Continence Society. Neurourology and Urodynamics: Official Journal of the International Continence Society, 21(2), 167-178.
  5. Rees, J., Bultitude, M., & Challacombe, B. (2014). The management of lower urinary tract symptoms in men. Bmj, 348, g3861.

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