Cross-cultural translation into Chinese and psychometric evaluation of a screening tool for benign prostatic enlargement

INTRODUCTION: We conducted a study to linguistically translate and psychometrically validate a translated and culturally adapted Chinese version of the European 3-item benign prostatic hyperplasia (BPH) screening tool (TOOL), then assess its diagnostic accuracy for identifying BPH with a prostate volume above 40 mL. METHODS: The study was conducted in two phases. The first phase involved a rigorous translation process performed by skilled multilingual translators using forward and backward translation techniques. The second phase focused on psychometric validation and was conducted in urology units across our hospital network. RESULTS: Sixty-six male patients of Chinese ethnicity, aged 18 to 90 years, who presented with lower urinary tract symptoms for at least 4 weeks were recruited. The study evaluated the TOOL's reliability, internal consistency, and validity, including convergent, concurrent, and criterion validity. Statistical analyses demonstrated strong internal consistency (Cronbach's alpha=0.890) and substantial test-retest reliability (intra-class correlation coefficient=0.715). The screening tool demonstrated moderate to strong correlations with both the International Prostate Symptom Score and prostate volume, supporting its validity. Furthermore, responsiveness analysis showed significant reductions in TOOL scores after surgery. The combination of the screening tool (cut-off: ≥3) and prostate-specific antigen level (cut-off: >2.35 μg/L) exhibited high sensitivity and specificity for detecting prostate volume above 40 mL (sensitivity: 92%, specificity: 73%; area under the receiver operating characteristic curve=0.842). CONCLUSION: These findings support the reliability and validity of the TOOL as a culturally adapted instrument for evaluating lower urinary tract symptoms in Chinese-speaking populations. Its use may improve the management of BPH.