Prostate enlargement diagnosis

Prostate enlargement diagnosis starts with the history and examination of the patient. Symptoms are scored to assess the severity of disease. (Read symptoms of prostate enlargement at BPH (Enlarged prostate) Symptoms). Per rectal examination in office room gives the initial clue to the enlargement of prostate. Since the urinary symptoms are not exclusive for prostate enlargement in men, few basic investigations are often required to reach final diagnosis before initiating treatment.

1. Urine examination – patient provides a sample of freshly passed urine in a sterile container. This test tells about presence of any infection in urine.
2. Uroflowmetry – In this test, patient need to hold urine till he gets urge to pass urine. Patient is asked to pass urine in a machine, which then generates a report about the flow of urine. After patient finished passing urine, the presence of any residual urine in bladder is checked by ultrasound.
3. Ultrasound abdomen – ultrasound is done to see the kidneys, bladder and size of prostate. Kidneys are part of urinary system and prostate enlargement can affect kidney function.
4. Serum creatinine – creatinine is marker of kidney function. Long term disease can lead to kidney damage and hence need for checking creatinine.
5.  Blood PSA – PSA is test done to screen patients aged 55-70 years to rule out presence of prostate cancer. Patient with prostate cancer have raised blood PSA levels. However PSA can be raised in other conditions also such as urine infection, prostate infection, urine retention, large prostate etc. Read more about serum PSA at Prostate cancer and PSA testing
6. TRUS – Trans rectal ultrasound (ultrasound probe passed through rectum) is conducted in office setting under local anaesthesia as it provides the more accurate size of prostate enlargement compared to abdominal ultrasound.
7. Endoscopy – Flexible endoscopy through urethra may be ordered by physician as per the symptoms of patients and ultrasound findings.  Patients having severe symptoms with normal prostate size on ultrasound may need this test. Flexible endoscopy is done under local anesthesia in office setting which gives visualised information about intraurethral prostate protrusion, and whether it is causing any mechanical obstruction. Sometimes physician advices about prostate operation based on endoscopy report even if size of prostate is normal on ultrasound.
8. Urodynamics – This test is selectively performed for patients who are suspected of having poor bladder contractility as the cause of his symptoms. These patients include those having symptoms of bed wetting, spontaneous urine leakage, neurological disorders, having previous prostate surgery etc.

After these tests the decision is taken by the doctor for treating the patient with either medicines or with surgery. Read treatment of enlarged prostate at Treatment of Benign Prostatic Enlargement