The Prostatitis Symptom Index can be used to clock improvements with therapy and document severity
| NIH Chronic Prostatitis Symptom Index Developed by the NIDDK-funded Chronic Prostatitis Collaborative |
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The file is in Word 97 format
and is available here: For those without word, available below
NIH Chronic Prostatitis Symptom Index
For each question – Circle the number that fits you.
Pain or discomfort
1. In the last week, have you experienced any pain or discomfort in the following areas?
Area between rectum and testicles (perineum) 1 Yes 0 No
Testicles 1 Yes 0 No
Tip of the penis (not related to urination) 1 Yes 0 No
Below your waist, in your pubic or bladder area 1 Yes 0 No
2. In the last week, have you experienced:
Pain or burning during urination? 1 Yes 0 No
Pain or discomfort during or after sexual climax (ejaculation)? 1 Yes 0 No
3. How often have you had pain or discomfort in any of these areas over the last week?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Usually
5 Always
4. Which number best describes your AVERAGE pain or discomfort on the days that you had it over the last week?
0=no pain, 1 2 3 4 5 6 7 8 9 10=Pain bad as you can imagine
Urination
5. How often have you had a sensation of not emptying your bladder completely after you finished urinating during the last week?
0 Not at all
1 Less than 1 time in 5
2 Less than half time
3 About half time
4 More than half time
5 Almost always
6. How often have you had to urinate again less than 2 hours after you finished urinating, over the last week?
0 Not at all
1 Less than 1 time in 5
2 Less than half time
3 About half time
4 More than half time
5 Almost always
Impact of symptoms
7. How much have your symptoms kept you from doing the kinds of things you would usually do, over the last week?
0 None
1 Only a little
2 Some
3 A lot
8. How much did you think about your symptoms during the last week?
0 None
1 Only a little
2 Some
3 A lot
Quality of life
9. If you were to spend the rest of your life with your symptoms just the way they have been during the last week, how would you feel about that ?
0 Delighted
1 Pleased
2 Mostly satisfied
3 Mixed (about equally satisfied and dissatisfied)
4 Mostly dissatisfied
5 Unhappy
6 Terrible
Scoring the Symptom Index Domains
Pain:Total of items 1 a, 1 b, 1 c, 1 d, 2a, 2b, 3, and 4
Urinary symptoms: Total of items 5 and 6
Quality of life impact: Total of items 7, 8, and 9
Pain and urinary score: Total of item 1 to 6
Total score:
(1) Calculate and report 3 separate scores (pain, urinary symptoms, and quality of life)
(2) Calculate and report a pain and urinary score (range 0-31), referred to as the “symptom scale score.”
Mild =0-9,
moderate=10-18
severe=19-31.
(3) Calculate and report total score (range 0-43), referred to as the “total score.” Assess patients at baseline and follow them over time using each patient as his own control. Can also use to compare to “norms” established and published.