What tests and laboratory studies are used to diagnose Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

Diagnosing benign prostatic hyperplasia (BPH) should involve a medical history, physical examination, International Prostate Symptom Score (IPSS), and urinalysis, as recommended by the most recent guidelines 1. The initial assessment of patients with suspected BPH includes:

• A detailed medical history to identify symptoms and potential causes
• A physical examination with digital rectal examination (DRE) to assess prostate size, consistency, and detect any nodules
• The IPSS questionnaire to quantify urinary symptoms
• Urinalysis to rule out infection or hematuria Further evaluation may include:
• Post-void residual (PVR) measurement to determine if the bladder empties completely
• Uroflowmetry to measure urine flow rate and identify obstruction patterns These diagnostic tools help confirm BPH diagnosis, assess its severity, rule out other conditions with similar symptoms, and guide appropriate treatment decisions. Additional tests, such as pressure-flow studies (urodynamics), cystoscopy, or transrectal ultrasound, may be necessary in some cases, but are not routinely recommended for initial evaluation 1. It is essential to prioritize the most recent and highest-quality study, which in this case is the 2021 guideline from the American Urological Association 1, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Diagnostic Tests for BPH

The following tests are used to diagnose Benign Prostatic Hyperplasia (BPH):

• Lower urinary tract symptoms evaluation with appropriate symptom scores 2, 3, 4
• Digital rectal examination 2, 3, 4, 5, 6
• Voiding charts 2
• Prostate-specific antigen (PSA) measurement 2, 3, 4, 5
• Urinalysis 2, 3, 4, 5, 6
• Imaging of the urinary tract 2, 4, 5
• Flow rate recording 4
• Residual urine volume measurement 4
• Frequency volume chart (for storage symptoms) 4
• Serum creatinine measurement 2, 4, 5
• Urine cytology 5
• Cystourethroscopy 5
• Post-void residual measurement 5
• Pressure-flow studies 5

Evaluation of BPH Symptoms

The evaluation of BPH symptoms includes:

• Medical history 4, 5, 6
• LUTS assessment using a symptomatic score 3, 4
• Physical examination including digital rectal examination 3, 4, 5, 6
• Assessment of bother related to LUTS 4
• Checking for possible complicated bladder outlet obstruction (BOO) 4