What questions should be asked when a patient complains of prostate problems?

Appropriate Questions for Patients Complaining of Prostate Problems

When evaluating a patient with prostate complaints, a structured approach using validated questionnaires like the International Prostate Symptom Score (IPSS) should be used to quantify symptoms and assess their impact on quality of life. 1, 2

Initial Symptom Assessment

• Ask about specific urinary storage symptoms including frequency, urgency, nocturia (number of times waking at night to urinate), and urgency incontinence 2
• Inquire about voiding symptoms such as hesitancy, intermittency, weak stream, straining to void, and sensation of incomplete emptying 2
• Determine if symptoms are predominantly storage or voiding in nature, as this helps differentiate between different prostate conditions 2
• Assess symptom severity using the International Prostate Symptom Score (IPSS), which includes seven questions evaluating both irritative and obstructive symptoms 1
• Ask about the impact of symptoms on quality of life using the Disease Specific Quality of Life question included in the IPSS 1, 2

Pain Assessment

• For patients with pain, ask about location (suprapubic, perineal, penile, testicular, or ejaculatory), timing, and factors that worsen or improve the pain 3
• Inquire if pain is related to urination, ejaculation, or specific activities 3, 4
• Ask about pain duration - chronic prostatitis is defined as pain for more than 3 of the previous 6 months 4

Medical and Surgical History

• Review previous urological conditions, procedures, or surgeries 2
• Ask about relevant medical conditions that may affect urinary function, such as cardiovascular disease, neurological conditions, and diabetes 2
• Review current medications, particularly those known to affect urinary function (e.g., diuretics, anticholinergics, alpha-agonists) 2
• Inquire about previous episodes of urinary tract infections or prostatitis 4

Risk Factor Assessment

• Ask about family history of prostate cancer or other urological malignancies 2
• Inquire about smoking history with specific pack-years 2
• For patients with hematuria, assess risk factors using appropriate risk stratification systems 2

Specific Questions for Different Prostate Conditions

For Suspected BPH:

• Ask about PSA levels if previously tested 5, 6
• Inquire about prostate size if known from previous examinations 6
• Ask about previous treatments for BPH and their effectiveness 5
• Determine if symptoms have progressively worsened over time 5

For Suspected Prostatitis:

• Ask about fever, chills, or other systemic symptoms that might indicate acute bacterial prostatitis 7
• Inquire about recurrent urinary tract infections with the same organism, suggesting chronic bacterial prostatitis 3, 4
• Ask about ejaculatory pain, which is common in chronic prostatitis/chronic pelvic pain syndrome 4
• Determine if there are associated bowel symptoms or nervous system manifestations 8

For Suspected Prostate Cancer:

• Ask about known stage and grade of cancer if previously diagnosed 5
• Inquire about baseline life expectancy considering age and comorbidities 5
• Ask about understanding of treatment options and their potential side effects 5

Functional Impact Assessment

• Ask how symptoms affect daily activities, sleep, and overall quality of life 1, 2
• Inquire about coping strategies the patient has already tried 3
• Ask about expectations for treatment outcomes 5

Common Pitfalls to Avoid

• Failing to quantify symptom severity using validated tools like IPSS can lead to inadequate treatment decisions 1, 2
• Not asking about impact on quality of life, which is crucial for treatment decisions 1, 2
• Overlooking the psychological impact of chronic prostate conditions, especially chronic prostatitis/chronic pelvic pain syndrome 3
• Focusing only on urinary symptoms and missing other manifestations like sexual dysfunction or pain 4, 9

By systematically addressing these questions, clinicians can better categorize prostate problems, assess their severity, and develop appropriate treatment plans that address both the physical symptoms and quality of life concerns.