How is BPH diagnosed?

You’ll have to do the talking.

First…

Your doctor will want to know about all of your symptoms, how severe they are, and how much they bother you. Your doctor may have you fill out a BPH Symptom Score Questionnaire that asks about how often you have urinary problems and how severe your urinary symptoms are. The answers to this questionnaire can help your doctor determine which types of treatment may be best for you, so it is in your best interest to be open and honest when you talk about your urinary symptoms. In some cases, your doctor may ask you to fill out a voiding diary, in which you describe your urination patterns.4

Your doctor will also ask about your medical history, including questions about your general health, any past problems with your bladder or prostate, any surgeries, and whether there is a history of BPH or prostate cancer in your family. 4

Next…

The doctor will perform a physical exam that focuses on your prostate and bladder. The doctor will feel the size of your prostate by putting a gloved, lubricated finger inside your rectum.2 This is called a digital rectal exam or DRE. It is important to remember that the size of the prostate is not always related to how bad your symptoms are or how severe the blockage of urine flow is. Every man is different…some men with only slightly enlarged prostates might have severe obstruction of urine flow and some with very large prostates may not have much blockage at all.2 But checking the size of the prostate does help your doctor decide which treatment options you should and should not consider.

The doctor may also perform a simple neurologic exam to rule out other physical causes of urinary symptoms.4

Then…

The doctor may be able to rule out other problems. In 8 out of 10 cases, urinary symptoms in older men are caused by BPH. But other more serious conditions can also cause similar symptoms. Your doctor has to rule out these conditions before a firm diagnosis of BPH can be made.2

A sample of your urine will be taken to check for signs of infection and rule out urinary tract infection, bladder stones, and other possible causes of urinary symptoms.4

Your doctor may also order a prostate-specific antigen (PSA) blood test to rule out prostate cancer as a possible cause of urinary symptoms.2 If prostate cancer is suspected, the doctor may order a rectal ultrasound and prostate biopsy (an examination of prostate tissue samples under a microscope). 2

At any time, your primary care physician may refer you to a urologist, a physician who specializes in problems of the male reproductive system and urinary tract.2

The urologist may perform some additional tests, including:

Urine flow study to see how fast urine is flowing through the urethra2
Cystoscopy to see inside the urethra and bladder and find out the location and extent of the problem2

Be prepared…

You can help yourself and your doctor by bringing all the right information with you to the first appointment. Here are three tips:

Print out this BPH Symptom Score Questionnaire from the American Urological Association, fill it out, and bring it with you.
Make a complete list of all medications you take, including non-prescription items (for colds, allergies, pain, etc.) and vitamins and supplements. Include the amounts and how often you take them. Bring this with you
Consider asking your spouse, partner, or a good friend to come with you. Another person can help to listen, ask questions, and even take notes

How to start the conversation with your doctor
In my control
For partners who care
Learn about treatment options for BPH

References

Fenter TC, Naslund MJ, Shah MB, et al. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006;12(4 suppl):S90-S98
National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No. 07-3012. June 2006.
Shvartzman P, Borkan JM, Stoliar L, et al. Second-hand prostatism: effects of prostatic symptoms on spouses’ quality of life, daily routines and family relationships. Family Pract. 2001;18:610-613.
American Urological Association. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003;170:530-547
Nickel JC. Comparison of clinical trials with finasteride and dutasteride. Rev Urol. 2004;6 Suppl 9:S31-9
Benign Prostatic Hyperplasia (BPH): A Patient’s Guide. Available at: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/patient-guides/bph_guide_2003.pdf. Accessed February 4, 2009.
Brawer MK. A multicenter study on the efficacy and safety of interstitial laser coagulation versus α-blockade in subjects with symptomatic benign prostatic hyperplasia: preliminary results. Rev Urol. 2005;7(suppl 9):S29-S33.
Medline Plus Medical Encyclopedia from NIH: Enlarged Prostate. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm. Accessed March 5, 2009.
Moriyama N, Nasu K, Takeuchi T, et al. Quantification and distribution of a1-adrenoceptor subtype mRNAs in human vas deferens: comparison with those of epididymal and pelvic portions. Br J Pharmacol. 1997;122:1009-1014.
Kuritzky L. A primary care physician’s perspective on benign prostatic hyperplasia. Rev Urol. 2003;5(suppl 5):S42-S48.
Wolters R, et al: Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care. BJU Int. 2002;90:655–661.
Rosen RC, Giuliano F, Cason CC. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 2005;47:824–837.
Ponholzer A, Madersbacher S. Lower urinary tract symptoms and erectile dysfunction; Links for diagnosis, management and treatment. Int J Impot Res. 2007;19:544-550.
National Institute on Aging: Talking With Your Doctor. Available at: http://www.nia.nih.gov/HealthInformation/Publications/TalkingWithYourDoctor/. Accessed March 5, 2009.
de Mey C, Michel MC, McEwen J, Moreland T. A double-blind comparison of terazosin and tamsulosin on their differential effects on ambulatory blood pressure and nocturnal orthostatic stress testing. Eur Urol. 1998;33(5):481-8.
http://www.dictionary.com
Atlas of Human Anatomy, Frank H. Netter, MD, Ciba-Geigy Corporation, Summit, NJ, 1989.

Talking to your doctor

It may help you to fill out the American Urological Association BPH Symptom Score Questionnaire.

Take the questionnaire >