How Is an Enlarged Prostate (BPH) Diagnosed?

If you are having trouble urinating, are bothered by a weak or intermittent urinary flow, and you are a man over age 50, you could have benign prostatic hyperplasia (BPH), or an enlarged prostate. If you experience these symptoms, make an appointment with your urologist.

Normal urination is essential to normal body functioning, and only a urologist will be able to determine why things are not working right. Here's a run-down on what to expect when you go to your healthcare provider's office.

Information Needed to Diagnose an Enlarged Prostate

When you go to your appointment, bring information on your current symptoms, as well as a written record of your past medical problems.

Your healthcare provider will ask if you are having difficulty urinating, a weak stream, or nighttime urinating. They will aslo want to know if you've noticed blood in your urine (hematuria) or if there is burning (dysuria).

You should also bring a complete list of all prescription and over-the-counter medicines that you are taking to see whether they are related to your symptoms. Certain drugs may interfere with urination. Over-the-counter medications, such as allergy and decongestant medicines, may prevent you from urinating. Other drugs that can make your symptoms more severe are opioids and anticholinergics.

Finally, tell your healthcare provider if you have a history of alcohol use. Alcohol can also interfere with urination.

Tests That Can Diagnose BPH

The following tests are sometimes used to diagnose BPH, but not all of them are always necessary. Your urologist will discuss with you which of these might be helpful in your case.

• The American Urological Association (AUA) BPH Symptom Index is a simple, seven-item, multiple-choice questionnaire that shows how severe your prostate symptoms are. You will be asked to rate how often you have had a variety of symptoms, such as not fully emptying your bladder, whether you need to urinate less than two hours after you last urinated, and whether you frequently get up during the night to urinate.
• Urodynamic testing helps your healthcare provider gather specific information on how well you are urinating, such as flow and whether you retain urine. If your urine stream is abnormal, your healthcare provider will need to pinpoint whether you have any anatomical reasons that explain this.
• Uroflowmetry measures how rapidly and fully your bladder empties, and it also helps evaluate whether there is any obstruction. With BPH, your prostate may be pushing hard on the urethra, making it difficult for you to have a steady stream of urine. You will be asked to urinate into a device that measures urine output and determines the time it takes you to urinate and the rate of the flow. A reduced flow rate may be a sign of BPH.
• Pressure flow studies measure pressure in the bladder while you are urinating. This test is considered one of the most accurate ways to determine if you have urinary blockage. Your urologist will insert a catheter into your urethra in the penis and into the bladder.
• The post-void residual (PVR) urine study measures how much urine is left in your bladder after you urinate. In general, if this measurement is between 100 to 200 milliliters or higher, it suggests that you have a urinary blockage. However, this test can be problematic. If you are anxious, you may not be able to urinate as you normally do, and the test may not be accurate.

Ruling Out Prostate Cancer

If you have symptoms of BPH, your healthcare provider might also test for prostate cancer. An early examination is important because only a comprehensive exam will determine whether you have BPH, which is a benign condition, or whether you have prostate cancer, which is best to diagnose early. Important tests for detecting prostate cancer include a digital rectal examination and prostate-specific antigen test.

• Digital rectal examination (DRE): During this test, your urologist will feel your prostate. The exam shows whether your prostate is hard or asymmetrical, both of which can be signs of cancer, or soft, which is less likely to indicate cancer. Your urologist will insert a lubricated, gloved finger into your rectum. If your healthcare provider feels anything that may indicate prostate cancer, you may need to have more tests to make an accurate diagnosis.
• Prostate-Specific Antigen (PSA) Test: This blood test measures a protein produced by the cells of the prostate gland. It is always done and evaluated in conjunction with a DRE.

It is important to recognize that a high PSA reading alone does not mean that you have cancer. An elevated PSA could be a sign of a number of conditions, including BPH, or prostatitis, an inflammation of the prostate. There is no evidence that prostatitis and BPH cause cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.

Additional Tests for Diagnosing BPH

Your urologist may have you undergo additional tests other than those listed above, particularly if your problems may be related to prostate cancer, bladder cancer, or are affecting your kidneys.

If You Are Diagnosed With BPH

Taken together, these tests will help your healthcare provider determine whether you have BPH and if you do, how severe it is. If you have BPH, your healthcare provider should provide you with information on whether simply monitoring your symptoms is a reasonable option, or whether treatment is a better option.

BPH can be treated medically or surgically in some cases.