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Symptom score

International Prostate Symptom Score (IPSS): your urinary symptom score

The IPSS is the 7-question American Urological Association (AUA) Symptom Index plus one question on how much your urinary symptoms bother you. It measures how severe urinary symptoms are. It is not a test for prostate cancer, and urinary symptoms are a reason to see a doctor.

Last reviewed: By the uncovermyrisk.com editorial team Educational only, not medical advice.

Over the past month:

7 symptom questions, scored 0 to 5, then 1 question on quality of life. The questions are in our own words. Nothing you choose leaves this page.

1. Incomplete emptying: How often did your bladder feel not fully empty after you finished urinating?
2. Frequency: How often did you have to urinate again less than two hours after you last finished?
3. Intermittency: How often did your stream stop and start again several times while you urinated?
4. Urgency: How often did you find it hard to put off urinating?
5. Weak stream: How often was your urine stream weak?
6. Straining: How often did you have to push or strain to start urinating?
7. Nocturia: On a typical night, how many times did you get up to urinate, from going to bed until getting up in the morning?
Quality of life: if you had to live the rest of your life with your urinary symptoms just as they are now, how would you feel about that? (optional, not added to the score)
Your result appears here

What you will see

Your symptom score out of 35, its group (mild, moderate or severe) and your quality-of-life answer.

Educational only, not medical advice. A symptom score, not a diagnosis and not a test for prostate cancer.

Source

AUA Symptom Index, Barry MJ and colleagues for the Measurement Committee of the American Urological Association, Journal of Urology 1992. Question topics and the 0 to 5 answers follow the AUA Symptom Score Index form printed by the NIH NIDDK repository; the questions here are reworded in our own words. Score groups and the quality-of-life question are as printed in open-access papers that reproduce the index (Gomez-Guerra 2009, Gilpin 2022).

Validated in

Developed and validated by the AUA committee in 210 men with benign prostatic hyperplasia (BPH) and 108 control subjects (Barry 1992).

Limits

Measures how severe urinary symptoms are; it cannot tell what causes them, and it does not test for prostate cancer. Other problems, such as bladder problems, infections or prostatitis, can cause the same symptoms. Our questions are reworded, so your score may differ slightly from the form your clinician uses. The score only reflects the past month and the answers you enter.

How the IPSS is scored

Each of the 7 symptom questions asks about the past month and is scored from 0 to 5: for six of them, 0 means "not at all" and 5 means "almost always"; for getting up at night, the score is the number of times, up to 5 or more (NIDDK AUA-SI form). The 7 scores are added for a total from 0 to 35 (NIDDK AUA-SI form). The index covers frequency, nocturia (getting up at night), weak stream, hesitancy, intermittency, incomplete emptying and urgency (Barry 1992).

Total scoreSymptom group
0 to 7Mild
8 to 19Moderate
20 to 35Severe

These are the groups studies use for the AUA Symptom Index (Gomez-Guerra 2009). The quality-of-life question is scored from 0, delighted, to 6, terrible (Gilpin 2022); it is reported next to the total, not added to it.

What the score can and cannot tell you

In the AUA committee's validation work, the score was consistent when men took it twice, matched how big a problem men said their symptoms were, and fell after prostate surgery, from an average of 17.6 before to 7.1 four weeks after (Barry 1992). That makes it useful for describing symptoms and following them over time.

It is not a diagnosis. Benign prostatic hyperplasia (BPH) means the prostate has grown larger than normal, and that growth is not caused by cancer (NIDDK BPH). But the same urinary symptoms can come from other problems, such as bladder problems, urinary tract infections, prostatitis or prostate cancer (NIDDK BPH). NIDDK advises discussing any urinary symptoms with a health care professional (NIDDK BPH). A low score does not rule anything out.

When to get care right away

NIDDK says to tell a health care professional right away if you cannot urinate at all; have painful, frequent and urgent needs to urinate with fever and chills; have blood in your urine; or have great discomfort or pain in your lower abdomen or urinary tract (NIDDK BPH).

Common questions

Is this a prostate cancer test?

No. The IPSS scores symptoms. Prostate cancer screening is a separate decision, usually about a PSA blood test: the USPSTF recommends that men 55 to 69 make an individual decision with their clinician (grade C) and recommends against PSA screening at 70 and older (grade D) (USPSTF 2018). See the prostate cancer screening age check.

Can medicines make symptoms worse?

Yes. NIDDK lists over-the-counter cold and cough medicines such as decongestants or antihistamines, tranquilizers, antidepressants and diuretics, and asks you to tell a health care professional if you take them (NIDDK BPH). Do not stop a prescribed medicine on your own.

Does a bigger prostate mean a higher score?

Not always. NIDDK notes that symptoms may not be directly related to prostate size: a large prostate may cause few symptoms, and a slightly enlarged one may cause more (NIDDK BPH).

Why is it called both IPSS and AUA Symptom Index?

The 7 symptom questions are the AUA Symptom Index (Barry 1992). The International Prostate Symptom Score uses the same 7 questions and adds the quality-of-life question (Gilpin 2022).

Also see the prostate cancer screening age check, the bladder cancer screening check and the screening tests by age.

Sources

  1. Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148(5):1549-1557. doi:10.1016/s0022-5347(17)36966-5. PMID 1279218. (Origin of the 7-item AUA Symptom Index; its abstract gives the validation groups, reliability and responsiveness. We read the abstract.) pubmed.ncbi.nlm.nih.gov/1279218/
  2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository. MAPP II study form: AUA Symptom Score Index (v2.0, 2015). Prints the 7 questions, each answered 0 to 5, and the total symptom score. repository.niddk.nih.gov/media/studies/mapp2sps/Forms/MAPPII_AUASI_v2.0.20150226.pdf
  3. Gomez-Guerra LS, Martinez-Fierro ML, Alcantara-Aragon V, et al. Population based prostate cancer screening in north Mexico reveals a high prevalence of aggressive tumors in detected cases. BMC Cancer. 2009;9:91. doi:10.1186/1471-2407-9-91. PMC2666762. (Table 1 prints the AUA Symptom Index groups: mild 0 to 7, moderate 8 to 19, severe 20 to 35.) pmc.ncbi.nlm.nih.gov/articles/PMC2666762/
  4. Gilpin L, Zekan D, Baugh B, et al. Evaluating the Efficacy of Employing Local Anesthetic Prostatic Blocks During Rezum Procedure. Cureus. 2022;14(9):e29598. doi:10.7759/cureus.29598. PMC9599892. (Table 5 reprints the International Prostate Symptom Score from Barry et al., including the quality-of-life question scored 0, delighted, to 6, terrible.) pmc.ncbi.nlm.nih.gov/articles/PMC9599892/
  5. National Institute of Diabetes and Digestive and Kidney Diseases. Enlarged Prostate (Benign Prostatic Hyperplasia). Last reviewed June 2024. www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/enlarged-prostate-benign-prostatic-hyperplasia
  6. US Preventive Services Task Force. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(18):1901-1913. www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-01. Spotted an error? See About.