Benign Prostate Hyperplasia Diagnosis
Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:
- Digital rectal exam. The doctor inserts a finger into the rectum to check your prostate for enlargement.
- Urine test. Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
- Blood test. The results can indicate kidney problems.
- Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.
After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These tests include:
- Urinary flow test. You urinate into a receptacle attached to a machine that measures the strength and amount of your urine flow. Test results help determine over time if your condition is getting better or worse.
- Postvoid residual volume test. This test measures whether you can empty your bladder completely. The test can be done using ultrasound or by inserting a catheter into your bladder after you urinate to measure how much urine is left in your bladder.
- 24-hour voiding diary. Recording the frequency and amount of urine might be especially helpful if more than one-third of your daily urinary output occurs at night.
If your condition is more complex, your doctor may recommend:
- Transrectal ultrasound. An ultrasound probe is inserted into your rectum to measure and evaluate your prostate.
- Prostate biopsy. Transrectal ultrasound guides needles used to take tissue samples (biopsies) of the prostate. Examining the tissue can help your doctor diagnose or rule out prostate cancer.
- Urodynamic and pressure flow studies. A catheter is threaded through your urethra into your bladder. Water — or, less commonly, air — is slowly injected into your bladder. Your doctor can then measure bladder pressure and determine how well your bladder muscles are working. These studies are usually used only in men with suspected neurological problems and in men who have had a previous prostate procedure and still have symptoms.
- Cystoscopy. A lighted, flexible instrument (cystoscope) is inserted into your urethra, allowing your doctor to see inside your urethra and bladder. You will be given a local anesthetic before this test.
A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:
- The size of your prostate
- Your age
- Your overall health
- The amount of discomfort or bother you are experiencing
If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.
Medication is the most common treatment for mild to moderate symptoms of prostate enlargement. The options include:
- Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate, making urination easier. Alpha blockers — which include alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax) and silodosin (Rapaflo) — usually work quickly in men with relatively small prostates. Side effects might include dizziness and a harmless condition in which semen goes back into the bladder instead of out the tip of the penis (retrograde ejaculation).
- 5-alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. These medications — which include finasteride (Proscar) and dutasteride (Avodart) — might take up to six months to be effective. Side effects include retrograde ejaculation.
- Combination drug therapy. Your doctor might recommend taking an alpha blocker and a 5-alpha reductase inhibitor at the same time if either medication alone isn’t effective.
- Tadalafil (Cialis). Studies suggest this medication, which is often used to treat erectile dysfunction, can also treat prostate enlargement.
Minimally invasive or surgical therapy
Minimally invasive or surgical therapy might be recommended if:
- Your symptoms are moderate to severe
- Medication hasn’t relieved your symptoms
- You have a urinary tract obstruction, bladder stones, blood in your urine or kidney problems
- You prefer definitive treatment
Minimally invasive or surgical therapy might not be an option if you have:
- An untreated urinary tract infection
- Urethral stricture disease
- A history of prostate radiation therapy or urinary tract surgery
- A neurological disorder, such as Parkinson’s disease or multiple sclerosis
Any type of prostate procedure can cause side effects. Depending on the procedure you choose, complications might include:
- Semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation)
- Temporary difficulty with urination
- Urinary tract infection
- Erectile dysfunction
- Very rarely, loss of bladder control (incontinence)
There are several types of minimally invasive or surgical therapies.