• Diagnosis of Benign Prostatic Hyperplasia (BPH)

    Your doctor will ask about your medical history. A physical exam will be done. The diagnosis of BPH is fairly obvious if you have the typical symptoms and you fit the risk profile—older male. At this point, the primary concern is that you do not have prostate cancer.
    Certain tests will be done to confirm the diagnosis of BPH and to rule out prostate cancer. . First is a digital rectal exam. For this exam, your doctor inserts a gloved finger into the rectum. From here, your doctor can feel the surface of the prostate. The size of your prostate will be estimate and your doctor will look for anal diseases, and possibly identify a cancer.
    Further testing will likely be done to check for cancer, determine the need for treatment, and to select the best treatment. Testing may include the following:
    General tests —These may include renal function tests with measuring of blood creatinine and a urinalysis, which is usually done with a dipstick.
    Prostate specific antigen (PSA) —PSA is a protein made by the prostate gland. PSA levels may increase when prostate cancer is present but other noncancerous conditions like BPH can also cause an increase in PSA. Your doctor may use these test results in conjunction with other tests to determine if your symptoms are caused by a cancer or BPH.
    Residual urine determination —This is a means of measuring the amount of urine left in your bladder after you have urinated. The amount of urine you cannot pass is important because that residual can lead to an infection or other kidney problems. For this test, your doctor will usually perform or obtain an abdominal ultrasound procedure to determine the volume of residual urine in your bladder. Alternatively, if a precise determination of the volume is indicated for clinical reasons, he may insert a catheter (tube) into your bladder after you have urinated.
    Urine flow study —This involves testing to determine how easily and rapidly your urine flows and how much pressure the bladder generates to empty itself. This will likely be done by a urologist, a specialist in diseases of the urinary tract.
    Cystoscopic examination —A cystoscope is a long, thin instrument that is inserted through the penis and into the bladder. This test is usually done in those patients in whom the diagnosis of BPH is in doubt. The cystoscope has a lens and light that allow the urologist to see the urethra, prostate, and bladder. Certain procedures can also be performed while under anesthesia using this instrument, such as opening up the passageway through the prostate.
    Cystometrogram —This test measures urine flow and bladder pressure. It is usually done in those patients who fail drug treatment or are being considered for a surgical procedure.
    Transrectal ultrasound —An ultrasound is a safe way to visualize internal organs. The closer the probe is to the target organ, the better the pictures. Therefore, the ultrasound probe is inserted into the rectum to take photos of the prostate, which is just millimeters away. Cancers of the prostate can be detected this way.

    References

    American Urological Association Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia. Available at: http://www.auanet.org/content/clinical-practice-guidelines/clinical-guidelines.cfm?sub=bph . Updated 2010. Accessed September 17, 2012.

    BPH diagnosis. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/#diagnosis . Accessed September 17, 2012.

    Diagnosis and testing of BPH. American Association of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/benign-prostatic-hyperplasia/diagnosis-tests.html . Updated December 2010. Accessed September 17, 2012.

    Burnett AL, Wein AJ. Benign prostatic hyperplasia in primary care: what you need to know. J Urol. 2006;175:S19-24.

    Dull P, Reagan RW Jr, Bahnson RR. Managing benign prostatic hyperplasia. Am Fam Physician. 2002;66:87-88.

    Members of the Prostate-Specific Antigen Best Practice Statement Panel (2009). Prostate-Specific Antigen Best Practice Statement: 2009 Update. Available at http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf . Accessed September 17, 2012.

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