The International Prostate Symptoms Score (IPSS)

The International Prostate Symptom Score (IPSS) is a scoring system used to screen for and diagnose benign prostatic hyperplasia (BPH) as well as to monitor symptoms and guide decisions about how to manage the disease.

The IPSS is based on the answers to eight questions, seven regarding disease symptoms and one question related to the patient’s quality of life.

For the symptom questions, the patient is asked to choose the rating that best represents their condition. The scale ranges from 1 to 5, with 5 representing the most symptomatic disease and giving an overall maximum possible score of 35. The answers to the quality of life question are scored on a scale of 1 to 6.

The symptom questions ask the patient to report on their experience of the following during the past month:

  • how often the bladder has felt like it s not completely emptied
  • how often there is an urge to urinate less than two hours after the last time
  • how often the flow has stopped and started again
  • how often it is difficult to withhold from urinating
  • how often the stream of urine is weak
  • how often urinating is a strain
  • how often one needs to get up at night to urinate

These symptom questions are the same as those used in the American Urological Association Symptom Index. According to these scoring systems, the scores can be categorized as follows

  • Symptoms are mild if the score is 7 or less
  • Symptoms are moderate if the score is 8 to19
  • Symptoms are severe if the score is 20 to 35

Quality of life, as perceived by the patient, is assessed using the eighth question as per recommendations from The International Scientific Committee (SCI), under the patronage of the World Health Organization (WHO) and the International Union Against Cancer (UICC). For responses to this question, a score of 6 means the patient perceives their quality of life as “terrible,” while a score of 0 indicates that a patient is delighted” with their quality of life.

International prostate symptom score (IPSS)

  Not at all Less than 1 time in 5 Less than half the time About half the time More than half the time Almost always Your score
Incomplete emptying
Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?
0 1 2 3 4 5  
Over the past month, how often have you had to urinate again less than two hours after you finished urinating?
0 1 2 3 4 5  
Over the past month, how often have you found you stopped and started again several times when you urinated?
0 1 2 3 4 5  
Over the last month, how difficult have you found it to postpone urination?
0 1 2 3 4 5  
Weak stream
Over the past month, how often have you had a weak urinary stream?
0 1 2 3 4 5  
Over the past month, how often have you had to push or strain to begin urination?
0 1 2 3 4 5  


  None 1 time 2 times 3 times 4 times 5 times or more Your score
Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?
0 1 2 3 4 5  


Total IPSS score  


Quality of life due to urinary symptoms Delighted Pleased Mostly satisfied Mixed – about equally satisfied and dissatisfied Mostly dissatisfied Unhappy Your score
If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? 0 1 2 3 4 5  



Further Reading

  • All Prostate Cancer Content
  • Prostate Cancer
  • The Prostate
  • Prostate Cancer Risk Factors
  • Prostate Cancer Screening

Last Updated: Feb 27, 2019

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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