Benign prostatic hyperplasia - Diagnosing prostate enlargement

Your GP will first need to determine whether your symptoms match the usual pattern of symptoms for people with prostate enlargement.

International Prostate Symptom Score (IPSS)

The next stage of the assessment is to calculate your International Prostate Symptom Score (IPSS).

This involves completing a questionnaire to assess your symptoms. Each question has five possible answers that carry a score and your overall score is used to assess the severity of your symptoms.

The checklist includes the following questions.

Over the past month:

• How often have you had the sensation of not completely emptying your bladder after urinating?
• How often have you had to urinate again less than two hours after finishing urinating?
• How often have you found that you stopped and started again when urinating?
• How often have you found it difficult to postpone urination?
• How often have you had a weak stream of urine?
• How often have you had to push or strain to begin urinating during the course of one night?
• How often have you had to get up during the night to urinate?

After your GP has assessed how severe your symptoms are, they will aim to rule out other conditions with similar symptoms through certain tests.

Ruling out other conditions

Ruling out other conditions is particularly important because the symptoms of prostate enlargement are similar to those of prostate cancer. Your GP has to be completely sure that your symptoms are not caused by cancer.

Urine tests

A urine test can be used to check if your symptoms are caused by an infection in your urinary system, such as a kidney or bladder infection.

Rectal examination

Your GP may carry out a rectal examination to check if you might have prostate cancer. Prostate cancer can cause the prostate gland to become hard and bumpy.

Your GP will put a glove on one hand and use a gel to lubricate one of their fingers. They will then gently push the finger into your anus and then up into your rectum. Because the rectum is close to the prostate gland, they will be able to check whether the surface of the gland has changed. The procedure will feel a little uncomfortable but it is not usually painful.

Prostate cancer does not always cause changes to the gland, so you will probably need to have some further tests to rule out prostate cancer.

Prostate-specific antigen (PSA) test

A blood test can be used to measure the amount of the prostate-specific antigen (PSA) protein that is produced by the prostate.

A raised PSA level indicates enlargement of the prostate and a significantly raised level may indicate prostate cancer. However, as with the rectal examination, a PSA test cannot give a definitive diagnosis of prostate cancer.

Transrectal ultrasound (TRUS)

A transrectal ultrasound (TRUS) is a type of ultrasound scan specifically designed to study the prostate and the surrounding area.

An ultrasound probe is placed into your rectum and uses soundwaves to build a detailed image of your prostate.

A TRUS measures the size of your prostate and can be used to either confirm or rule out a diagnosis of prostate cancer.

Intravenous urography (IVU)

An intravenous urography (IVU) is an X-ray used to study the urinary tract (kidneys, bladder and tube through which urine passes).

An IVU can be used to check for blockages in your urinary system that could be causing your symptoms, such as a kidney or bladder stone. An IVU can also detect any damage caused to the urinary tract.

During an IVU, you will be injected with a harmless radioactive dye, which will appear on the X-rays. After 30 to 60 minutes, the dye should have passed into your urinary tract and a series of X-rays will be taken. In some cases, you may be asked to pass urine before the final X-ray is taken.

Voiding charts

A voiding chart is a urination diary, which you may be asked to keep for 24 hours. You will be asked to record how often you urinate, as well as details about how you urinate – for example, whether your urination is stopping and starting or whether it is difficult to start urinating.

A voiding chart is a good way to find out more information about your symptoms and can be used to determine the type of treatment that would be most effective in controlling your symptoms.

Uroflowmetry

Uroflowmetry measures the pressure of your bladder and how well your bladder works when you urinate.

You will be given a local anaesthetic and a small flexible tube (catheter) will be inserted into your urethra and moved up into your bladder.

Water will then be injected through the catheter and into your bladder. A computer connected to the catheter measures the pressure inside your bladder and can assess how well your bladder is working.

As with voiding charts, uroflowmetry is a good way of determining what type of treatment will help control your symptoms.