BPH or Enlarged Prostate — Diagnosis

You may first notice BPH or enlarged prostate symptoms yourself, or your doctor may notice that your prostate is enlarged during a routine examination. If your primary care doctor suspects that you have BPH or enlarged prostate, he or she may refer you to a urologist — a doctor who specializes in problems of the urinary tract and male reproductive system.

Tests for BPH or Enlarged Prostate

Your doctor may perform some or all of the following tests to confirm or rule out the presence of BPH or enlarged prostate.

Digital Rectal Examination (DRE) — this is usually the first test performed. During the examination, the doctor inserts a gloved and lubricated finger into the rectum to feel the prostate. This examination allows the doctor to get a general idea of the size and condition of your prostate.
International Prostate Symptom Score (IPSS) or AUA Symptom Index — a short questionnaire that asks about specific urinary symptoms associated with BPH or enlarged prostate and how often they occur.
Urinalysis — a laboratory test of your urine performed to rule out the presence of an infection or condition that may produce similar symptoms.
Prostate-Specific Antigen (PSA) blood test — used to rule out prostate cancer as the cause of your symptoms. PSA is a protein produced by cells in the prostate, and the level of this protein is elevated in the blood in men who have prostate cancer or BPH.

If the results of these tests suggest that you may have BPH or enlarged prostate, your doctor will probably perform additional examinations to help confirm the diagnosis and determine the severity of the condition.

Such tests may include:

Urinary flow study — measures the strength and amount of your urine flow.
Imaging tests — ultrasound may be performed to estimate the size of the prostate and may also be used to look for prostate stones, kidney stones or obstructions, or a tumor.
Cystoscopy — a cystoscope (a thin tube containing a lens with a light system) is inserted into the urethra so the doctor can detect problems, including prostate enlargement or the development of stones in your bladder.
Urodynamic studies — your doctor may recommend a series of tests to measure bladder pressure and function if he or she suspects your symptoms might be related to a bladder problem or a neurological problem, and not BPH or enlarged prostate.
Post-void residual volume test — ultrasound imaging is used to determine if you can empty your bladder.