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), urinalysis, and prostate-specific antigen (PSA) testing, 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
• A physical examination, including a digital rectal examination (DRE)
• Utilization of the IPSS to evaluate symptom severity
• Urinalysis to rule out infection or other conditions with similar symptoms
• Blood tests, including PSA testing, to help distinguish BPH from prostate cancer Some patients may also require:
• Post-void residual volume measurement to determine how completely the bladder empties
• Uroflowmetry to measure urine flow rate and pattern
• Assessment of prostate size and shape via abdominal or transrectal ultrasound, or cystoscopy, or by preexisting cross-sectional imaging (i.e., magnetic resonance imaging/computed tomography) prior to surgical intervention for LUTS/BPH, as recommended by the AUA guideline amendment 2019 1. In some cases, additional tests such as cystoscopy or urodynamic studies may be necessary to evaluate bladder function and determine the severity of BPH. 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 be guided by the most recent and highest-quality evidence, such as the AUA guideline on management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part I-initial work-up and medical management 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