BPH: Diagnosis (Benign Prostatic Hyperplasia/Enlarged Prostate)
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.
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:
- prostate specific antigen (PSA), a blood test to screen for prostate cancer
- urinary cytology, a urine test to screen for bladder cancer
- a measurement of post-void residual volume (PVR), the amount of urine left in the bladder after urinating
- uroflowmetry, or urine flow study, a measure of how fast urine flows when a man urinates
- cystoscopy, a direct look in the urethra and/or bladder using a small flexible scope
- urodynamic pressure-flow study that tests the pressures inside the bladder during urination
- 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?
AUA Guidelines: Management of BPH
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Common misspellings: enlarged prostate big prostate
Reviewed January 2011