What are the diagnostic tests for Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

The diagnostic tests for Benign Prostatic Hyperplasia (BPH) should include a combination of physical examinations, laboratory tests, and symptom assessment questionnaires, such as the International Prostate Symptom Score (IPSS), with additional tests like uroflowmetry, post-void residual volume measurement, and transrectal ultrasound as needed, as recommended by the most recent guidelines 1. The initial evaluation of patients presenting with bothersome Lower Urinary Tract Symptoms (LUTS) possibly attributed to BPH should involve a medical history, physical examination, IPSS, and urinalysis, as stated in the 2021 AUA guideline 1. Some key points to consider in the diagnostic workup of BPH include:

• A digital rectal examination (DRE) to assess prostate size and texture
• Urinalysis to rule out infection or other conditions with similar symptoms
• Blood tests, including prostate-specific antigen (PSA) testing, to help distinguish BPH from prostate cancer
• Symptom assessment questionnaires, such as the IPSS, to evaluate severity
• Additional tests, such as uroflowmetry, post-void residual volume measurement, and transrectal ultrasound, may be used to further evaluate patients and guide treatment options, as recommended by the 2019 AUA guideline amendment 1. It is essential to note that the choice of diagnostic tests may vary depending on the individual patient's symptoms, medical history, and treatment plans, and should always prioritize minimizing morbidity, mortality, and improving quality of life, as emphasized in the 2003 AUA guideline on management of BPH 1.

From the Research

Diagnostic Tests for Benign Prostatic Hyperplasia (BPH)

The diagnostic tests for BPH include:

• Lower urinary tract symptoms evaluation with appropriate symptom scores, such as the International Prostate Symptom Score (IPSS) questionnaire 2, 3, 4, 5, 6
• Digital rectal examination (DRE) 2, 3, 4, 5, 6
• Voiding charts 2
• Prostate-specific antigen (PSA) measurement 2, 3, 5, 6
• Creatinine measurement 2
• Urinalysis 2, 5
• Imaging of the urinary tract 2
• Transabdominal ultrasound to measure the prostate volume, intravesical prostatic protrusion (IPP) and the post void residual (PVR) urine 4
• Assessment for bladder distention or neurologic impairment 5
• American Urological Association Symptom Index 5
• Quality of Life (QOL) index 4

Evaluation Steps

The evaluation steps for BPH include:

• Medical history 6
• Symptom assessment with IPSS questionnaire 6
• DRE and PSA measurement 6
• Classification of BPH according to the degree of IPP using grades 1 to 3 4
• Staging of BPH according to the presence or absence of bothersome symptoms and significant obstruction 4