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Self-rating Prostatic Symptoms scores

This questionnaire helps you evaluate how severe your prostatic symptoms are. For each question, circle the value that matches your answer.

Date : _____________________________

Question Never Less than
1 time
in 5		 Less than
half the time		 About half
the time		 More than
half the
time		 Almost
always
1. 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
2. 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
3. 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
4. Over the last month, how difficult have you found it to postpone urination? 0 1 2 3 4 5
5. Over the past month, how often have you had a weak urinary stream? 0 1 2 3 4 5
6. Over the past month, how often have you had to push or strain to begin urination? 0 1 2 3 4 5
7. 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? None

0

 1 time

1

 2 times

2

 3 times

3

 4 times

4

 5 times +

5

Total score: ________________
Compile your total score. If your total is 7 or less, your symptoms are mild. If it is between 8 and 19, you are moderately symptomatic. A score of 20 ore more means that your symptoms are severe. Use this test over time to measure the evolution of your symptoms.

Generally, during the last month, you were annoyed by problems to urinate?
0. Not annoyed at all ☐
1. little annoyed ☐
2. Averagely annoyed ☐
3. Annoyed a lot ☐
 
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. Delighted ☐
1. Pleased ☐
2. Mostly satisfied ☐
3. Mixed - about equally ☐
4. Mostly dissatisfied ☐
5. Unhappy ☐
6. Terrible ☐
Source : International Prostatic Symptoms Quotation Scale (I-PSS).

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The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.

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