From the Guidelines
Diagnosing benign prostatic hyperplasia (BPH) involves a thorough medical history, symptom assessment using standardized questionnaires like the International Prostate Symptom Score (IPSS), digital rectal examination (DRE), and laboratory tests including urinalysis and prostate-specific antigen (PSA) blood test, as recommended by the most recent guidelines 1. The diagnostic criteria for BPH include:
- A thorough medical history to identify symptoms and potential causes of lower urinary tract symptoms (LUTS)
- Symptom assessment using standardized questionnaires like the International Prostate Symptom Score (IPSS) to evaluate the severity of symptoms
- Digital rectal examination (DRE) to feel the size and consistency of the prostate gland
- Laboratory tests, including:
- Urinalysis to rule out infection
- Prostate-specific antigen (PSA) blood test to help distinguish BPH from prostate cancer
- Possibly kidney function tests to evaluate renal function Urodynamic studies, such as measuring urine flow rate and post-void residual volume, may be conducted to further evaluate LUTS and guide treatment decisions, as suggested by the American Urological Association (AUA) guidelines 1. In some cases, imaging studies like transrectal ultrasound or cystoscopy may be necessary to visualize the prostate and bladder, especially when considering invasive therapies or to evaluate prostate size and anatomy, as recommended by the AUA guidelines 1. A urinary flow test (uroflowmetry) measures the strength and amount of urine flow, which can help predict the response to surgery and guide treatment decisions, as noted in the AUA guidelines 1. These diagnostic tools help determine the severity of BPH and guide appropriate treatment decisions, prioritizing morbidity, mortality, and quality of life as outcomes, as emphasized by the AUA guidelines 1.
From the Research
Diagnostic Criteria for Benign Prostatic Hyperplasia (BPH)
The diagnostic criteria for BPH include:
- A history of lower urinary tract symptoms, including onset, duration, and severity 2
- Physical examination, including a digital rectal examination (DRE) to assess prostate size and consistency 3, 4, 2
- Assessment of bladder distention or neurologic impairment 2
- Serum prostate-specific antigen (PSA) measurement to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms 4, 2, 5
- Urinalysis to help identify infection, genitourinary cancer, or calculi as an alternative cause of lower urinary tract symptoms 2
- Validated, self-administered symptom questionnaires, such as the International Prostate Symptom Score (IPSS) or American Urological Association Symptom Index, to assess BPH severity 3, 4, 2
Diagnostic Tests
Diagnostic tests available for general practitioners to diagnose BPH include:
- Medical history 4
- Symptom assessment with IPSS questionnaire 3, 4
- Digital rectal examination (DRE) 3, 4, 2
- Prostate-specific antigen (PSA) measurement 4, 2, 5
Referral Criteria
Referral to a urologist can be considered for patients with:
- A rising PSA, especially while on 5-alpha reductase inhibitors (5-ARIs) 3
- Failure of urinary symptom control despite maximal medical therapy 3, 4
- Suspicion of prostate cancer 3, 4
- Hematuria 3
- Recurrent urinary infections 3
- Urinary retention 3, 4
- Renal failure 3
- IPSS > 20 4
- PSA > 10 ng/ml or PSA > 4 ng/ml and free PSA < 20% 4
- Patients < 50 years with suspected BPH 4
- Any urological complication 4