Exams and Tests

Your doctor will first want to make sure that your urination problem is caused by benign prostatic hyperplasia (BPH) and not by something else. This can usually be determined from your medical history, a physical exam that focuses on the urinary tract, a urinalysis, and a blood test. A neurological exam should also be done to determine whether your symptoms are related to a problem with the nerves to the bladder. A questionnaire such as the American Urological Association (AUA) symptom index may be used to evaluate how bothersome your symptoms are. It is not used to diagnose BPH.

Tests that are often done

• A digital rectal exam checks the size and firmness of the prostate. The size of the prostate does not always determine the severity of the symptoms. A man with only a small degree of prostate enlargement may have more severe symptoms than a man with more enlargement.
• A urinalysis and urine culture check for a urinary tract infection that might be the cause of the symptoms.
• A blood creatinine test checks how well your kidneys are working.
• A prostate-specific antigen (PSA) test helps check for prostate cancer, which can cause the same symptoms as BPH.

Tests that are used as needed

If your symptoms are moderate to severe, additional tests, called urodynamic studies, may be done.

• Post-void residual urine test (PVR) measures the amount of urine left in the bladder after urination. This test is done using ultrasound or a small tube (catheter) put into the bladder through the urethra.
• Pressure flow studies measure pressure in the bladder while urinating. They may help distinguish between urinary symptoms caused by obstruction, such as BPH, and those caused by a problem affecting the bladder muscles or nerves.
• Cystometrogram measures the bladder's pressure, compliance, and capacity during urinary storage. This may include a uroflowmetry test, which measures how fast the urine flows out of the bladder.

Tests that may be done

The following tests may be done if you have complications of BPH or if there is a need to look for other causes of the symptoms.

• Ultrasound uses sound waves to check the size and structure of the kidneys, bladder, and prostate. A small device called a transducer is inserted into the rectum (transrectal ultrasound) to evaluate the prostate.
• Cystoscopy allows the doctor to look inside the urethra and bladder. This may allow the doctor to see the extent of blockage of the urethra caused by an enlarged prostate and estimate its severity.
• Intravenous pyelogram (IVP) uses X-rays to show the function of the kidneys and the flow of urine from the kidneys to the bladder.
• Spiral (helical) computed tomography (CT) scan uses X-rays to make detailed pictures of structures inside the body. These scanners can check for an enlarged prostate gland, blockage, and urine flow from the kidneys.

Early Detection

There is no routine screening test for prostate enlargement. But it may be detected during other screening tests that are regularly done to check for prostate or rectal cancer, such as the digital rectal exam and prostate-specific antigen (PSA) test.

• Many doctors recommend yearly digital rectal exams and PSA tests for all men over age 50 to check for prostate cancer. But some doctors don't recommend this type of regular screening, saying there is no proof that such routine testing results in more successful treatment of prostate cancer.
• The best screening method and schedule for you may depend on other risk factors you have. Talk with your doctor about this.