Diagnosing BPH
You may first notice symptoms of BPH yourself, or your doctor may suspect it when asking questions about your health and symptoms. Your doctor may ask you how often you have symptoms associated with an enlarged prostate, how severe they are, and how often the affect your life. Your doctor may also find that your prostate is enlarged during a routine checkup. When BPH is suspected, your doctor will want to ensure that your symptoms, and urinary problems, are caused by benign prostatic hyperplasia and not by something else.
Several tests help the doctor identify the problem and decide whether surgery is needed. Some of the more common tests are:
International Prostate Symptoms Score (IPSS)
The IPSS helps evaluate the lower urinary tract symptoms. The score is calculated by the patient answering questions regarding his own experiences – the higher the score, the more severe the condition. As it is calculated based on the patient’s answers it is a good assessment of the effect of urinary symptoms on the quality of the person’s life.
To determine your IPSS Score use our free and simple Prostate Symptoms Calculator.
Other indexing tests to help assess the impact on a man’s quality of life include the BPH Impact Index (PII) and the Symptom Problem Index (SPI).
Digital Rectal Examination (DRE)
This examination is usually the first test done, and is done to check the size and firmness of the prostate. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This examination gives the doctor a general idea of the size and condition of the gland.
The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.
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Urinalysis and Urine Culture Test
One of the most common forms of medical analysis, a doctor will often times perform a urinalysis to determine whether you may have a urinary tract infection (UTI) that might be causing the symptoms. While UTI’s are usually associated with females, urinary tract infections in men are not uncommon. The most common type of UTI is a bladder infection which is also often called cystis.
Prostate-Specific Antigen (PSA) Blood Test
To rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer. The U.S. Food and Drug Administration (FDA) has approved a PSA test for use in conjunction with a digital rectal examination to help detect prostate cancer in men who are age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about the interpretation of PSA levels, the test's ability to discriminate cancer from benign prostate conditions, and the best course of action following a finding of elevated PSA.
PSA levels between 4 and 10 ng/mL (nanograms per milliliter) are considered to be suspicious and should be followed by a rectal ultrasound and, if indicated, prostate biopsy. PSA is false positive-prone (7 out of 10 men in this category will still not have prostate cancer) and false negative-prone (2.5 out of 10 men with prostate cancer have no elevation in PSA). Recent reports indicate that refraining from ejaculation 24 hours or more prior to testing will improve test accuracy
A PSA test is recommended once a year for all men over the age of 50, and for men over the age of 40 who are at higher risk for prostate cancer based on risk factors.
A fact sheet titled “The Prostate-Specific Antigen (PSA) Test: Questions and Answers” can be found on the National Cancer Institute website.
Rectal Ultrasound and Prostate Biopsy
If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. Depending on the reason for the exam, an instrument called a proctoscope may be inserted into the rectum. An ultrasound transducer is then inserted either through the proctoscope or by itself, into the rectum. The ultrasound transducer sends and receives sound waves at the prostate, with the echo patterns of the sound waves forming an image of the prostate gland on a display screen.
To determine whether an abnormal-looking area is indeed a tumor, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumor. The needle collects a few pieces of prostate tissue for examination with a microscope.
You may have slight discomfort for a short time during the biopsy. Your doctor may take several biopsies in different areas to ensure an accurate diagnosis. An antibiotic is prescribed for 24 hours following a biopsy.
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Urine Flow Test or Uroflowmetry
A urine flow test, also referred to as uroflow or uroflowmetry, is a test to evaluate the speed of urination, and the total time of urination. It is utilized to determine abnormalities in the bladder function including a narrowed or obstructed urethra and a weakened bladder or bladder muscle. It is a simple, painless procedure without side effects.
During a urine flow test, the patient urinates into a uroflowmeter – a funnel-shaped device that reads, measures, and computes the amount and rate of urine flow. A reduced flow often times suggests BPH. You may be asked to urinate privately into a toilet that contains a collection device and scale. This equipment creates a graph that shows changes in flow rate from second to second so the doctor or nurse can see the peak flow rate and how many seconds it took to get there. Results of this test will be abnormal if the bladder muscle is weak or urine flow is obstructed.
Cystoscopy
A cystoscopy is an examination of the inside of the bladder and urethra. In this examination, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system that help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the prostate gland and identify the location and degree of the obstruction.
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Post-void residual urine test (PVR)
A post-void residual urine test (PVR) is a test that measures the amount of urine left in the bladder after urination. This test is typically done through ultrasound, and less commonly through the insertion of a small tube or catheter into the bladder through the urethra.
A post-void residual of more than 200 mL, about half a pint, is a clear sign of a problem. Even 100 mL, about half a cup, requires further evaluation.
A post void residual urine greater than 50mL is considered to be significant, and increases the potential for urinary tract infections (UTI). In adults over the age of 60, 50-100ml of post void residual urine may remain after urinating due to the effects of BPH. However, the amount of post-void residual can be different each time you urinate.
Cystometry or Cystometrogram (Measurement of Bladder Pressure)
A cystometrogram (CMG) measures how much your bladder can hold, how much pressure builds up inside your bladder as it stores urine, and how full it is when you feel the urge to urinate. The doctor or nurse will use a catheter to empty your bladder completely. Then a special, smaller catheter will be placed in the bladder. This catheter has a pressure-measuring device called a manometer. Another catheter may be placed in the rectum to record pressure there as well. Your bladder will be filled slowly with warm water. During this time you will be asked how your bladder feels and when you feel the need to urinate. The volume of water and the bladder pressure will be recorded. You may be asked to cough or strain during this procedure. Involuntary bladder contractions can be identified.
Measurement of Leak Point Pressure
While your bladder is being filled for the CMG, it may suddenly contract and squeeze some water out without warning. The manometer will record the pressure at the point when the leakage occurred. This reading may provide information about the kind of bladder problem you have. You may also be asked to apply abdominal pressure to the bladder by coughing, shifting position, or trying to exhale while holding your nose and mouth. These actions help the doctor or nurse evaluate your sphincter muscles.
Pressure Flow Study
After the CMG, you will be asked to empty your bladder. The catheter can measure the bladder pressures required to urinate and the flow rate a given pressure generates. This pressure flow study helps to identify bladder outlet obstruction that men may experience with prostate enlargement. Bladder outlet obstruction is less common in women but can occur with a fallen bladder or rarely after a surgical procedure for urinary incontinence. Most catheters can be used for both CMG and pressure flow studies.
Electromyography (Measurement of Nerve Impulses)
If your doctor or nurse thinks that your urinary problem is related to nerve or muscle damage, you may be given an electromyography. This test measures the muscle activity in and around the urethral sphincter by using special sensors. The sensors are placed on the skin near the urethra and rectum or they are located on the urethral or rectal catheter. Muscle activity is recorded on a machine. The patterns of the impulses will show whether the messages sent to the bladder and urethra are coordinated correctly.
