Evaluation for BPH involves a discussion of the man's medical and family history, a physical examination, a digital rectal examination (DRE), and an analysis of his symptoms. Laboratory, imaging, and other types of tests may be used to determine the size of the prostate and to rule out other diseases or conditions that may be causing or exacerbating the symptoms.
Laboratory tests may include:
- Prostate specific antigen (PSA) – a test that measures the level of PSA, a protein produced by prostate cells, in the blood; it is often elevated in men with prostate cancer but can also be elevated in those with BPH, although levels are usually only slightly elevated. When evaluating the results, the doctor must consider both the concentration of PSA in the blood and the size of the man's prostate; an elevated PSA with a very large prostate is less concerning than the same value when the prostate is only slightly enlarged.
- Urinalysis – a group of tests used to look for signs of a urinary tract infection (UTI)
- Urine culture – another test used to look for indication of a UTI
- Blood urea nitrogen (BUN) and Creatinine – blood tests to evaluate kidney function
Non-laboratory tests may include:
- Ultrasound – to help measure the size of the prostate and evaluate the volume of urine retained in the bladder
- Cystoscopy – an evaluation of the urethra and/or bladder using a thin, flexible scope
- Urine flow and/or pressure studies – to evaluate how fast urine can travel through the urethra and how much pressure is being put on the bladder by urine retention
- Prostate biopsy – collection of one or more small samples of prostate tissue and evaluation of its cellular structure under the microscope for abnormal cells and any signs of prostate cancer