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IPSS: Visual alternatives to aid comprehension and new risk prediction models

Presented by
Dr Florine Schlatmann; Prof. Stavros Gravas
EAU 2021
Many patients find it difficult to complete the international prostate symptom score (IPSS) questionnaire, making its reliability uncertain. To gain insight into the problems with understanding the IPSS, a qualitative study assessed this questionnaire and 2 visual alternatives [1]. Furthermore, a predictive analytics solution was developed to project the change in lower urinary tract symptoms (LUTS) and risk of acute urinary retention or benign prostatic hyperplasia (BPH)-related surgery [2].

Up to 29% of Europeans have a limited health literacy, leading to difficulty with completing the IPSS questionnaire. This led to the development of 2 visual alternatives: the South African Visual Prostate Symptom Score (VPSS) and the French Score Visuel Prostatique en Images (SVPI). In a first qualitative study, the IPSS and the 2 visual alternatives were assessed by Dr Florine Schlatmann (University Medical Centre Groningen, the Netherlands) and colleagues [1]. It was found that visual alternatives are better understood, especially when combined with short textual questions. Based on their findings, the researchers developed a modified questionnaire named the Dutch Reduced Illustrated Prostate Symptom Score (DRIPSS) to reduce problems with understanding.

A second study by Prof. Stavros Gravas (University of Thessaly, Volos, Greece) aimed to predict changes in IPSS score [2]. Over 9,000 patients were included from 3 placebo-controlled trials on dutasteride (i.e. ARIA3001, ARIA3002, and ARIB3003) and 1 trial comparing dutasteride, tamsulosin, and combination (i.e. CombAT). Two independent models were developed to predict responses to active treatments over 4-year of follow-up:

  • a Generalised Least Squares model for longitudinal IPSS; and
  • a Cox proportional hazards model for time to first acute urinary retention or BPH-related surgery.

The models provided an interactive visualisation to predict outcomes for any combination of predictors which could define a patient’s risk profiles.

The models performed heterogeneously across studies. Predictions for active treatments were well calibrated, although some heterogeneity was found. For patients at relatively lower risk of disease progression (i.e. with an IPSS of 12–19, a prostate volume of 30–50 mL, a PSA level of 1.5–4 ng/mL, a Qmax of >11 mL/s, and post-void residual urine of <70 mL), the combination of dutasteride and tamsulosin was predicted to be more effective than tamsulosin in improving LUTS and reducing the risk of acute urinary retention or BPH-related surgery for up to 4 years. These models may be able to predict changes in IPSS and the risk of surgery for LUTS patients at risk of disease progression. Such predictive analytics could aid in the decision-making of the optimal treatment per patient.

  1. Schlatmann FWM, et al. First qualitative study into comprehensibility of IPSS and 2 visual alternatives for men with adequate and men with limited health literacy skills, leading to a new, better understood alternative: Dutch Reduced Illustrated Prostate Symptom Score (DRIPSS). P0040, EAU21 Virtual, 8–12 July 2021.
  2. Gravas S, et al. A new risk calculator to predict changes in IPSS score and risk of AUR / BPH-related surgery in BPH patients with moderate-severe symptoms at risk of disease progression receiving placebo, dutasteride, tamsulosin, or combination therapy. P0036, EAU21 Virtual, 8–12 July 2021.


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