Recommended Initial Evaluation for BPH with LUTS
The International Prostate Symptom Score (IPSS) is part of the recommended initial evaluation for patients with suspected BPH and LUTS (Answer: B). 1, 2, 3
Mandatory Components of Initial Assessment
The American Urological Association guidelines clearly delineate which tests are required versus optional in the initial workup:
Required Initial Tests
- Medical history including onset, duration, and severity of lower urinary tract symptoms 1, 4
- Physical examination with digital rectal examination (DRE) to assess prostate size and characteristics 1, 2
- International Prostate Symptom Score (IPSS) or AUA Symptom Index for symptom quantification 1, 2, 3
- Urinalysis to identify infection, hematuria, or other urinary tract pathology 1, 2, 4
Recommended but Not Mandatory
- Serum PSA testing is recommended for patients with life expectancy >10 years when knowledge of prostate cancer would change management 1, 2, 5
Why the Other Options Are Incorrect
CT Scan of Abdomen (Option A)
- Not part of routine initial evaluation 1
- Imaging is only indicated when history, physical examination, or urinalysis suggest underlying renal disease, urinary retention, or complications 1
- Routine measurement of serum creatinine is not even recommended, as baseline renal insufficiency from BPH occurs in well under 1% of patients 1
Routine Cystoscopy (Option C)
- Not recommended as part of initial evaluation 1
- Cystoscopy is considered an optional test that may aid decision-making when initial evaluation suggests a non-prostatic cause or when the patient selects invasive therapy 1
- It is not performed routinely on all patients presenting with suspected BPH 1
Prostate Biopsy (Option D)
- Not part of initial BPH evaluation 6
- Biopsy is only indicated when there is abnormal PSA or suspicious DRE findings suggesting possible prostate cancer 1, 6
- Patients with abnormal PSA require referral to a urologist for evaluation before treatment 6
Clinical Significance of IPSS
The IPSS serves multiple critical functions in BPH management:
- Quantifies symptom severity using seven questions, classifying symptoms as mild (0-7), moderate (8-19), or severe (20-35) 1, 3
- Superior to unstructured interview for documenting baseline symptoms 1
- Guides treatment decisions based on symptom severity and bother 1, 2, 3
- Monitors treatment response at follow-up visits 2, 3
- Detects symptom progression in patients managed with watchful waiting 1
Common Pitfall to Avoid
Do not rely on symptom scores alone to determine need for intervention. 1 An intervention may be more appropriate for a moderately symptomatic patient who finds symptoms bothersome than for a severely symptomatic patient who finds symptoms tolerable. 1 The degree of bother caused by symptoms is a critical factor in determining management approach, not just the IPSS score itself. 2, 3