From the Guidelines
Testing for benign prostatic hyperplasia (BPH) should start with a digital rectal exam (DRE), blood tests including the prostate-specific antigen (PSA) test, and urinalysis to rule out infections or other urinary tract issues. These initial steps are crucial in assessing the size and condition of the prostate, as well as identifying any potential infections or other conditions that may be causing symptoms 1.
Initial Evaluation
The initial evaluation for BPH typically involves:
- A digital rectal exam (DRE) to feel the size and condition of the prostate
- Blood tests, including the PSA test, to measure a protein produced by the prostate
- Urinalysis to rule out infections or other urinary tract issues
- Completing a questionnaire about urinary symptoms, such as the International Prostate Symptom Score (IPSS)
Additional Tests
Additional tests may include:
- Uroflowmetry to measure urine flow strength and volume
- Post-void residual volume test to check if the bladder empties completely
- Imaging tests like ultrasound or cystoscopy (inserting a small camera into the urethra) in some cases
Recent Guidelines
According to the most recent guidelines, the 2023 European Association of Urology guidelines on the management of non-neurogenic male lower urinary tract symptoms recommend a similar approach, emphasizing the importance of a thorough initial evaluation and the use of additional tests as needed 1.
Importance of Recent Evidence
It's essential to prioritize the most recent and highest-quality studies when making recommendations for testing and treatment. In this case, the 2023 guidelines provide the most up-to-date information on the best practices for diagnosing and managing BPH.
Conclusion Not Needed
The focus is on providing the best possible care based on the most recent evidence, prioritizing morbidity, mortality, and quality of life as outcomes.
From the Research
Diagnostic Tests for Benign Prostatic Hyperplasia (BPH)
- Medical history: assessing the onset, duration, and severity of lower urinary tract symptoms and medication use to rule out other causes of symptoms 2
- Symptom assessment: using validated, self-administered symptom questionnaires such as the American Urological Association Symptom Index or International Prostate Symptom Score (IPSS) 3, 2
- Digital rectal examination (DRE): to rule out prostate cancer or neurological problems, and to estimate prostate volume 3, 4, 2, 5
- Prostate-specific antigen (PSA) measurement: to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms, and to predict disease progression 3, 4, 2
- Urinalysis: to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms 2, 6
- Transrectal ultrasonography: to estimate the exact prostate size and guide treatment 4, 5
Referral Criteria to Urology
- Patients with BPH who do not show any improvement at the third month of treatment with alpha-blockers, or the sixth month with 5-alpha reductase inhibitors 3
- Patients with lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10 ng/ml or PSA>4 ng/ml and free PSA<20% 3
- Patients <50 years with suspected BPH, or with any urological complication 3
Treatment Guidance
- Alpha blockers are first-line medications for BPH 2, 6
- 5-alpha reductase inhibitors may decrease prostate size and alter the disease course, and are recommended for patients with a large prostate 3, 5, 6
- Surgical referral is indicated if BPH-related complications develop, medical therapy fails, or the patient chooses it 2, 6