From the Guidelines
Benign prostatic hyperplasia (BPH) diagnosis should begin with a detailed discussion of urinary symptoms using the International Prostate Symptom Score (IPSS) questionnaire to assess severity, as recommended by the AUA guideline 1. The diagnosis of BPH typically involves a combination of medical history, physical examination, and diagnostic tests.
Key Diagnostic Steps
- A digital rectal examination (DRE) is essential to evaluate prostate size, consistency, and to check for any abnormalities that might suggest cancer.
- Laboratory tests include urinalysis to rule out infection, prostate-specific antigen (PSA) blood test to help differentiate BPH from prostate cancer, and kidney function tests.
- Additional diagnostic procedures may include uroflowmetry to measure urine flow rate, post-void residual volume measurement to check for retained urine, and in some cases, cystoscopy to visualize the urethra and bladder.
- Transrectal ultrasound might be used to accurately measure prostate size and guide biopsy if cancer is suspected, as suggested by the 2019 AUA guideline amendment 1.
Importance of Diagnostic Tests
- The AUA-Symptom Index and urinalysis are crucial in the initial evaluation of patients presenting with bothersome LUTS possibly attributed to BPH 1.
- Post-void residual assessment and uroflowmetry are also important considerations prior to surgical intervention for LUTS/BPH 1.
- These diagnostic steps help confirm BPH while excluding other conditions with similar symptoms, such as prostate cancer, urinary tract infections, or neurological disorders affecting bladder function.
Prioritizing Patient Care
- Early diagnosis allows for timely treatment to prevent complications like urinary retention, bladder stones, or kidney damage.
- The primary goal of BPH diagnosis is to improve patient outcomes, reduce morbidity, and enhance quality of life, as emphasized by the AUA guideline 1.
From the Research
BPH Diagnosis
- Benign prostatic hyperplasia (BPH) is a common condition that increases in prevalence with age 2
- A history should include onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms 2
- Physical examination includes a digital rectal examination and assessment for bladder distention or neurologic impairment 2
- Recommended tests include serum prostate-specific antigen measurement and urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms 2
Diagnostic Tests
- BPH severity is assessed using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score 2
- Initial assessment should include medical history, LUTS assessment using a symptomatic score, physical examination including digital rectal examination, urinalysis, flow rate recording, and residual urine volume 3
- Frequency volume chart is recommended when storage symptoms are predominant 3
- Serum PSA should be done when the diagnosis of prostate cancer can modify the management 3
Diagnosis Challenges
- Diagnosing BPH can be challenging because lower urinary tract symptoms are found in conditions other than BPH, and prostate size correlates poorly with symptoms of obstruction 4
- A careful medical history and physical examination, along with prudent use of diagnostic tests, can yield an accurate diagnosis 4