Benign Prostatic Hypertrophy (BPH)

Diagnosis

BPH can be diagnosed by clinical examination and/or by simple non-invasive tests.

Clinical Examination

It is important that the abdomen is examined to check that the bladder is not overfilled. A digital rectal examination (DRE) can assess the prostate size and may help determine whether the prostate feels benign or otherwise.

Tests

Initially, simple non-invasive tests are appropriate.

Flow rate (FR): This involves passing urine into a bucket and measuring the speed of the urinary flow.

Ultrasound (U/S): This assesses the kidneys and, particularly, whether the bladder empties properly. A full bladder is required, before the U/S. It is then necessary to pass urine and return for another U/S after which it is possible to calculate how much urine remains in your bladder (post micturition residual – PMR). It is important to try and empty your bladder as completely as possible so that an accurate measure is obtained. There is evidence that if a FR and U/S are repeated over three consecutive tests, your best flow rate and least PMR will be achieved by the third attempt.

Symptom scores: The most common and best validated is the International Prostate Symptom Score (IPSS) of the American Urology Association (AUA) which consists of 8 questions. The first 7 refer to filling and voiding symptoms and each is scored between 0 (no problem) to 5 (worst) giving total scores ranging between 0 and 35. Scores up to 12 are generally considered to indicate mild, between 12 and 25 moderate and above 25 severe symptoms. The eighth question asks about the impact you perceive your symptoms to have on your quality of life.

To download the IPSS form, please click here

Frequency volume diary: This involves recording the time and volume of each urinary void over a 7 day period (although 3 to 4 days may be enough). This means urinating into a measuring jug and measuring the volume (in millilitres) each time.

Blood and urine tests: A dipstick test of your urine may identify abnormalities such as the presence of blood or an infection (in which case a sample may also be sent to the laboratory for more sophisticated investigations). A blood test for kidney function (creatinine) may be suggested and sometimes a prostatic specific antigen (PSA) test is recommended. The PSA test can give an indication of the prostatic size as well as indicate the possible benefit of therapy. There is no definite evidence as yet that a PSA test will accurately identify cancer at a time when treatment might be of benefit.

More invasive tests: In a few cases, where it is not possible to make a diagnosis from the above tests, a bladder pressure test (Urodynamics or Cystometrogram) may be required. Fine thin tubes are placed in the bladder and the pressure is measured as the bladder fills and as you pass urine. It may also be useful to do an ultrasound examination of your prostate through the back passage (Transrectal Ultrasound or TRUS). Each of these tests contributes to pin pointing in the most accurate way the likeliest cause of the symptoms, thereby directing the most appropriate treatment.

Risk factors for progression

These include prostate size (>40g), age (over 70 years), FR (<10m/second), worsening symptom scores, increasing PMR (>150ml) and PSA (>1.4ng/ml),