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Tests and diagnosis
By Mayo Clinic staffAn evaluation for enlarged prostate will likely include:
- Detailed questions about your symptoms. Your doctor will also want to know about other health problems, medications you're taking and whether there's a history of prostate problems in your family. Over-the-counter (OTC) drugs, such as aspirin, decongestants and antacids, are considered medications, so tell your doctor about those too. Your doctor may have you complete a symptom questionnaire.
- Digital rectal exam. Wearing a lubricated examination glove, your doctor gently inserts a finger into your rectum. Because the prostate is located next to the rectum, your doctor can determine whether your prostate is enlarged and check for signs of prostate cancer.
- Urine test. Analyzing a sample of your urine in the laboratory can help rule out an infection or other conditions that cause BPH-like symptoms, such as temporary inflammation of the prostate (prostatitis), bladder infection and kidney disease.
Other tests your doctor may use to help confirm a BPH diagnosis include:
- Transrectal ultrasound (TRUS). This test estimates the size of your prostate gland and can be helpful in diagnosing or ruling out prostate cancer. After a lubricating gel is applied to your rectum, the ultrasound probe — about the size and shape of a large cigar — is inserted. Sound waves bouncing off your prostate create an image of your prostate gland. Ultrasound takes about five minutes and isn't painful, though you may feel some uncomfortable pressure.
- Urodynamic pressure-flow studies. This test measures bladder pressure and function while you urinate. After you receive a local anesthetic, a small catheter is threaded through your urethra into your bladder. Water is slowly injected into your bladder to measure internal bladder pressure and to determine how effectively your bladder contracts. Bladder pressure and urinary flow may be measured while you urinate. The test takes 30 to 60 minutes. Generally this test is reserved for men with complicated or unusual urinary symptoms.
- Cystoscopy. This procedure allows your doctor to see inside your urethra and bladder. After you receive a local anesthetic, a thin tube containing a lighted lens (cystoscope) is gently inserted into your urethra. Your doctor can tell if you have urethral compression caused by an enlarged prostate, blockage of the urethra or bladder neck, anatomical abnormalities, or bladder stones. The instrument is inside you for five minutes or less. The procedure can be moderately painful.
- Intravenous pyelogram or CT urogram. These studies use X-ray images of your urinary tract to help find obstructions and other abnormalities. These tests are most often used for those who have bladder stones, blood in the urine (hematuria) or frequent urinary tract infections. Dye containing iodine is injected into a vein, and an X-ray or CT scan is taken of your kidneys, bladder and the tubes that connect your kidneys to your bladder (ureters). The dye helps outline the drainage systems of the kidneys. If you're allergic to iodine, you may need special preparation for these tests or an alternative test that doesn't use dye.
Additional tests sometimes used to evaluate BPH include:
- Prostate-specific antigen (PSA) blood test. It's normal for your prostate gland to produce PSA, which helps liquefy semen. A small amount of PSA normally circulates in your blood. Higher than normal PSA values are often associated with BPH — but some men have normal PSA values despite having an enlarged prostate. Higher than normal levels in your blood also can be signs of prostate cancer or an inflamed prostate (prostatitis). Most doctors use this test in men with BPH to be sure that a hidden prostate cancer isn't missed.
- Urinary flow test. This test measures the strength and amount of your urine flow. You urinate into a receptacle attached to a special machine. The test takes no longer than a normal urination. Charting the results of this test over time helps determine if your condition is getting better or worse. It's normal for peak urine flow to decrease with age, but it can also be a sign of BPH or a weakened bladder muscle.
- Postvoid residual volume test. This test measures whether you can empty your bladder completely. The test is done one of two ways: by inserting a thin, soft tube (catheter) into your urethra through your penis and up into your bladder after you urinate, or by using ultrasound imaging to measure the size of your bladder after you urinate. Ultrasound is more commonly used and less uncomfortable. Test results can vary, so you may need to have it done more than once to determine an accurate pattern. These tests take only a couple of minutes.
