Britishjournal of Urology (1995), 76, 451-458 Validation of the self-administered Danish Prostatic Symptom Score (DAN-PSS-1) system for use in benign prostatic hyperplasia B.J. HANSEN, H. FLYGER*, K. BRASSOf, J. SCHOtJt, J. NORDLINGt, J. THORUP ANDERSEN$, S. MORTENSENS, H-H. MEYHOFF*, S. WALTER7 andT. HALDt Department of Urology, Bispebjerg Hospital, Copenhagen, *Department of Surgery A, Section of Urology, Hillerad Hospital, Hillerod, f Department of Urology, Herlev Hospital, Herlev, #Department of Urology, Hvidovre Hospital, Hvidovre, 5 Department of Surgery D, Section of Urology, Glostrup Hospital, Glostrup and 7 Department of Surgery A, Section of Urology, Odense Hospital, Odense, Denmark Objective To validate the Danish Prostatic Symptom Score (DAN-PSS-l), a self-administered quality-of-life questionnaire comprising 12 questions related to void- ing problems and the perceived bother of each individ- ual symptom. Methods Using published results from several compari- sons of other symptom scoring systems with DAN- PSS-1, the test-retest reliability, internal consistency, construct and content validity, and responsiveness of the DAN-PSS-1 system were assessed. Results The system was internally consistent (Cronbach’s alpha = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%) and the questionnaire was well understood by the patients. The DAN-PSS-1 system demonstrated a high degree of construct validity, correlating with the extensively used Madsen-Iversen score system (Spearman’s correlation coefficient, r, = 0.5 1) and with the patients’ answers to questions about how bothersome their symptoms were (rs = 0.71). The DAN-PSS-1 system discriminated clearly between patients with benign prostatic hyperplasia (BPH) and control subjects (an area under the receiver operating characteristic curve of 0.94). Finally, the DAN-PSS-1 was sensitive to changes following inter- vention, with scores decreasing from a median of 20 to zero 4 months after patients underwent transur- ethral prostatectomy and from a median of 11.5 to 7.5 (65%) after patients had received 4 months treat- ment with an alpha-blocker. Conclusions The DAN-PSS-1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints sugges- tive of BPH and in the follow-up after intervention. Keywords Benign prostatic hyperplasia, Danish Prostatic Symptom Score (DAN-PSS-l), validation Introduction Benign prostatic hyperplasia (BPH) is common in older men and the most frequent cause of urinary outflow obstruction [l]. Furthermore, BPH is a disease with a significant impact on the quality of life, primarily by producing bothersome lower urinary tract symptoms (LUTS). Garraway et al. [2], in a recent cross-sectional survey, found that almost 25% of men over 40 years of age have LUTS. Most patients seek treatment for BPH because of bothersome symptoms which affect the quality of their lives. In recent years, the indications for treat- ment have been mostly relative, relying on the com- plaints of the informed patient. Consequently, careful analysis of the symptomatology is crucial in counselling Accepted for publication 23 May 1995 0 1995 British Journal of Urology the patient [3]. Therefore, it is important to quantify the symptoms, both for determining the severity of the disease and for documenting the response to therapy. The single most important outcome for the patient is the relief of bothersome symptoms, and thereby improve- ment in his quality of life, rather than improvements in flow rate, detrusor pressure or other urodynamic factors [4]. Given the central role of LUTS, it is important to establish tools with which to assess the patient’s symp- toms and follow them over time to determine the pro- gression of the disease, the efficacy of interventions using different therapeutic modalities and comparisons among them. At least two significant attempts have been made to develop such tools. The first symptom-score system was developed by Boyarsky et al. [5] and the second by Madsen and Iversen [6]. Both reports classified symptoms 451