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Preface and Contents

Benign Prostatic Hyperplasia (BPH)

Diagnosis of BPH

Diagnosis of BPH

When history and symptoms suggest BPH, the following tests are performed to confirm or rule out the presence of an enlarged prostate.

  • Digital rectal examination (DRE) In this examination, a lubricated, gloved finger is gently inserted into the patient’s rectum to feel the surface of the prostate gland through the rectal wall. This examination gives the doctor an idea of the size and condition of the prostate gland.

    In BPH, on DRE, the prostate is enlarged, smooth, and firm in consistency. Hard, nodular and irregular feel of the prostate on DRE suggests cancer or calcification of prostate gland.

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  • Ultrasound and post-void residual volume test An ultrasound can estimate the size of the prostate and detect other problems such as malignancy, dilatation of the ureter and the presence of a kidney abscess.

    Ultrasound imaging is also used to determine the quantity of urine left in the bladder after urination. Post-void residual urine volume less than 50 ml indicates adequate bladder emptying. Post-void residual urine volume of 100 to 200 ml or higher is considered to be significant and further evaluation is needed.

  • Prostate symptom score or index The International Prostate Symptom Score (IPSS) or AUA (American Urological Association) symptom index helps in the diagnosis of BPH. In this diagnostic modality, patients are asked about the presence or absence of common symptoms of benign prostatic hyperplasia. The answers are then scored and, on the basis of the calculated prostate symptoms score, the severity of the urinary problem is judged.
  • Laboratory tests Laboratory tests do not help diagnosing of BPH. But they help in the diagnosis of associated complications and excluding problems with similar presentation. Urine is tested for infection and blood is tested for kidney function.
  • Prostate Specific Antigen (PSA) is a screening blood test for cancer of the prostate.
  • Other investigations Different investigationsperformed to diagnose or exclude the diagnosis of BPH are uroflowmetry, urodynamic studies, cystoscopy, prostate biopsy, intravenous pyelogram or CT urogram and retrograde pyelography.
Can a person with symptoms of BPH have prostate cancer? How is prostate cancer diagnosed?

Yes. Many symptoms of prostate cancer and BPH are similar, so on the basis of clinical symptoms it is not possible to differentiate between the two conditions. But remember, BPH is not related to prostate cancer. Three most important tests which can establish the diagnosis of prostate cancer are digital rectal examination (DRE), blood test for prostate- specific antigen (PSA) and prostate biopsy.

Blood PSA test is an important screening test for the diagnosis of cancer of the prostate.