A doctor makes a diagnosis of BPH based on description of symptoms, medical history, physical examination, and various blood and urine tests. The doctor may recommend that the patient sees a urologist for complex test procedures.
Some diagnostic tests are used to rule out cancers of the prostate or bladder as the cause of symptoms. In some cases, symptoms of prostate cancer can be similar to those of BPH. Tests may also be performed to see if BPH has caused any kidney damage.
The doctor will ask about the patient’s personal and family medical history, including past and present medical conditions. The doctor will also ask about any medications the patient may be taking that could cause urinary problems
Digital Rectal Exam. The digital rectal exam is used to detect an enlarged prostate. The doctor inserts a gloved and lubricated finger into the patient's rectum and feels the prostate to estimate its size and to detect nodules or tenderness. The exam is quick and painless. The test helps rule out prostate cancer or problems with the muscles in the rectum that might be causing symptoms, but it can underestimate the prostate's size. It is never the sole diagnostic tool for either BPH or prostate cancer.
Other Physical Examinations. The doctor will usually press on and manipulate (palpate) the abdomen and sides to detect signs of kidney or bladder abnormalities. Certain procedures that test reflexes, sensations, and motor response may be performed in the lower body to rule out possible neurologic causes of bladder dysfunction.
Prostate Specific Antigen (PSA) Test
A PSA test measures the level of prostate-specific antigen (PSA) in the patient's blood. It is a widely used but controversial screening test for prostate cancer. High PSA levels may indicate prostate cancer, but BPH itself usually raises PSA levels. [For more information, see In-Depth Report #33: Prostate cancer.]
A urinalysis can detect signs of bleeding or infection. A urinalysis involves a physical and chemical examination of a urine sample. A urinalysis also helps rule out bladder cancer.
To determine whether the bladder is obstructed, an electronic test called uroflowmetry measures the speed of urine flow. To perform this test, the patient urinates into a special toilet equipped with a measuring device. A reduced flow may indicate BPH. However, bladder obstruction can also be caused by other conditions including weak bladder muscles and problems in the urethra.
Review Date: 07/20/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.