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Diagnosis of BPH

Throughout a man's life, his prostate may become larger and start to cause problems as he ages. But what are some of those problems? How do I know if I have BPH? When should I see a doctor? What kinds of tests will my doctor perform? The following should help answer these questions as well as others.

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What is the prostate?

The prostate is part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum, and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.

What is BPH?

Benign prostatic hyperplasia (BPH), also known as lower urinary tract symptoms (LUTS), is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH.

What are some of the risk factors for BPH?

Risk factors for developing BPH include increasing age and a family history of BPH.

What are some of the symptoms associated with BPH?

Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, sometimes as often as every one to two hours, especially at night. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, or that a man cannot postpone urination once the urge to urinate arises. BPH can cause a weak urinary stream, dribbling of urine, or the need to stop and start urinating several times when the bladder is emptied. BPH can cause trouble in starting to urinate, often requiring a man to push or strain in order to urinate. In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.

How is BPH diagnosed?

In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur. This helps measure how severe the BPH is — ranging from mild to severe.

When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the doctor will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation. These include:

1. prostate specific antigen (PSA), a blood test to screen for prostate cancer
2. urinary cytology, a urine test to screen for bladder cancer
3. a measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
4. uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates
5. cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope
6. urodynamic pressure-flow study that tests the pressures inside the bladder during urination
7. ultrasound of the kidney or the prostate

When should I see a doctor about BPH?

A man should see a doctor if he has any of the symptoms mentioned previously that are bothersome. In addition, he should see a doctor immediately if he has blood in the urine, pain with urination, burning with urination or is unable to urinate.

Frequently asked questions:

Is BPH a rare condition?

No, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, and so yearly physical examinations and PSA tests are highly recommended to eliminate cancer diagnosis.

Are there risks in not seeking treatment for BPH?

In the majority of men BPH is a progressive disease. It can lead to bladder damage, infection, blood in the urine, and even kidney damage. It is therefore important for men with this condition to continue to be followed.

Which type of drugs are the best?

To date, there is not enough research data to predict who will respond to medical therapy or which drug will be better for an individual patient. There are a variety of drugs available and, in some men, a combination of drugs may work best.

How do I know if oral medications are the best treatment for me?

If you are diagnosed with BPH, you should discuss all treatment options with your urologist. Together, you can decide whether medication, minimally invasive therapy or surgical treatment is best for you.

Where can I get more information?

Benign Prostatic Hyperplasia (BPH) Treatment Choices

AUA Guidelines Patient Guides: BPH: A Patient's Guide

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Common misspellings: enlarged prostate big prostate

Reviewed November, 2006

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Glossary Terms

bladder:
	The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.
BPH:
	Also known as benign prostatic hyperplasia. An enlarged prostate not caused by cancer. BPH can cause problems with urination because the prostate squeezes the urethra at the opening of the bladder.
cancer:
	An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.
cyst:
	An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.
cystoscopy:
	Also known as cystourethroscopy. An examination with a narrow, flexible tube-like instrument passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
cytology:
	The examination of cells obtained from the body tissue or fluids, especially to establish if they are cancerous.
diagnosis:
	The process by which a doctor determines what disease or condition a patient has by studying the patient's symptoms and medical history, and analyzing any tests performed (e.g., blood tets, urine tests, brain scans, etc.).
DRE:
	Also known as digital rectal examination. Insertion of a gloved, lubricated finger into the rectum to feel the prostate and check for any abnormalities.
ejaculatory:
	Involved in or related to the structure involved in the release of semen from the penis during orgasm.
gene:
	The basic unit capable of transmitting characteristics from one generation to the next.
gland:
	A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.
hyperplasia:
	Excessive growth of normal cells of an organ.
infection:
	A condition resulting from the presence of bacteria or other microorganisms.
invasive:
	Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.
ions:
	Electrically charged atoms.
kidney:
	One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.
penis:
	The male organ used for urination and sex.
post-void residual volume:
	A diagnostic test that measures how much urine remains in the bladder after urination.
prostate:
	A walnut-shaped gland in men that surrounds the urethra at the neck of the bladder. The prostate supplies fluid that goes into semen.
prostatic:
	Pertaining to the prostate.
PSA:
	Also referred to as prostate-specific antigen. A protein made only by the prostate gland. High levels of PSA in the blood may be a sign of prostate cancer.
PSA test:
	Also referred to as prostate-specific antigen test. A blood test used to help detect prostate cancer.
pus:
	The yellowish or greenish fluid that forms at sites of infection.
rectal:
	Relating to, involving or in the rectum.
rectum:
	The lower part of the large intestine, ending in the anal opening.
stage:
	Classification of the progress of a disease.
ultrasound:
	Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.
urethra:
	A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.
urge:
	Strong desire to urinate.
urinal:
	A portable device that is used as a receptacle for urine.
urinalysis:
	A test of a urine sample that can reveal many problems of the urinary system and other body systems. The sample may be observed for physical characteristics, chemistry, the presence of drugs or germs or other signs of disease.
urinary:
	Relating to urine.
urinary cytology:
	Inspection under a microscope of cells found in the urine.
urinary tract:
	The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.
urinate:
	To release urine from the bladder to the outside. Also referred to as void.
urination:
	The passing of urine.
urine:
	Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.
urine flow study:
	A test in which the patient urinates into a special device that measures how quickly the urine is flowing.
uroflow:
	Urination flow.
uroflowmetry:
	A urodynamic test that measures urine flow either visually, electronically, or with the use of a disposable flowmeter unit.
urologist:
	A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)
vas:
	Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

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