Can Benign Prostatic Hyperplasia (BPH) be diagnosed clinically?

From the Guidelines

Benign Prostatic Hyperplasia (BPH) can be diagnosed clinically through a comprehensive evaluation, including a physical examination, medical history, and assessment of lower urinary tract symptoms (LUTS) 1. The diagnosis of BPH relies on identifying a persistent pattern of LUTS, such as urinary frequency, urgency, and weak stream, which can be assessed through patient interviews and voiding diaries 1. A physical examination, including a digital rectal examination (DRE) and a focused neurologic examination, should be performed to exclude locally advanced prostate cancer and other conditions that may produce LUTS 1. The assessment typically involves:

• A urinalysis to screen for hematuria and urinary tract infection (UTI) 1
• Measurement of the serum prostate-specific antigen (PSA) in patients with at least a 10-year life expectancy and for whom knowledge of the presence of prostate cancer would change management 1
• Optional diagnostic tests, such as urinary flow-rate recording and measurement of post-void residual urine (PVR), may be considered in patients with complex medical histories or those desiring invasive therapy 1 No laboratory tests or imaging studies can confirm BPH; it's a clinical diagnosis based on the patient's history and presentation 1. A thorough evaluation is essential as BPH often co-occurs with other conditions, which can complicate the diagnostic picture 1. Early and accurate diagnosis is crucial for implementing appropriate treatment strategies, including watchful waiting, medical therapy, or invasive therapy 1.

From the FDA Drug Label

Patients in A Long-Term Efficacy and Safety Study had moderate to severe symptoms at baseline (mean of approximately 15 points on a 0 to 34 point scale). Although an early improvement in urinary symptoms was seen in some patients, a therapeutic trial of at least 6 months was generally necessary to assess whether a beneficial response in symptom relief had been achieved The improvement in BPH symptoms was seen during the first year and maintained throughout an additional 5 years of open extension studies.

Diagnosis of BPH can be supported clinically by the presence of symptoms such as obstructive symptoms (impairment of size and force of stream, sensation of incomplete bladder emptying, delayed or interrupted urination) and irritative symptoms (nocturia, daytime frequency, need to strain or push the flow of urine), as well as an enlarged prostate upon digital rectal examination 2.

From the Research

Diagnosis of Benign Prostatic Hyperplasia (BPH)

• BPH can be diagnosed clinically through a combination of medical history, symptom assessment, digital rectal examination, and prostate-specific antigen (PSA) measurement 3, 4, 5, 6, 7
• The International Prostate Symptom Score (IPSS) questionnaire is a useful tool for assessing symptoms and guiding treatment decisions 3, 4, 7
• A digital rectal examination is a mandatory test for the assessment and diagnosis of BPH 3, 5, 7

Diagnostic Tests and Evaluations

• The basic evaluation of patients with BPH should include:
  • Lower urinary tract symptoms evaluation with appropriate symptom scores 5, 7
  • Digital rectal examination 3, 5, 7
  • Voiding charts 5
  • Prostate-specific antigen and creatinine measurement 5, 7
  • Urinalysis 5
  • Imaging of the urinary tract 5
• The IPSS questionnaire can help identify patients with mild, moderate, or severe symptoms, and guide treatment decisions 3, 4, 7

Treatment and Referral Guidelines

• Treatment options for BPH include watchful waiting, medical therapy, and surgery 3, 4, 6, 7
• Referral to a urologist may be considered for patients with a rising PSA, failure of urinary symptom control, suspicion of prostate cancer, or other complications 3, 4