Best Tests for Diagnosing Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia is the non-cancerous enlargement of the prostate gland. As men age, hormonal changes can cause the prostate to grow, potentially leading to lower urinary tract symptoms (LUTS) [2]. These symptoms occur because the enlarged prostate compresses the prostatic urethra, obstructing urine flow.

Common Symptoms of BPH in Men [3]:

• Frequent urination, especially at night (nocturia)
• Urgency to urinate
• Difficulty starting urination
• Weak or interrupted urine stream
• Straining while urinating
• Feeling of incomplete bladder emptying
• Dribbling at the end of urination
• Urinary incontinence

It’s important to distinguish BPH from prostate cancer. Although both conditions affect the prostate, BPH is not cancerous [4]. Recognising these symptoms of benign prostatic hyperplasia is the first step toward diagnosis and treatment.

Different prostate problems, including prostate cancer, prostatitis, and BPH, can have similar symptoms. Prostate tests help health care professionals diagnose the specific cause of your symptoms, ensuring you receive appropriate treatment for benign prostatic hyperplasia and to help improve symptoms.

Health practitioners may recommend prostate tests if you have [1]:

• Symptoms attributed to benign prostatic hyperplasia, such as:
• Urinary frequency, urgency, or nocturia
• Trouble starting urination or a weak urine stream
• Urine blockage or urinary retention
• Bladder control problems (urinary incontinence)
• Urine with an unusual colour or odour
• Painful urination or ejaculation

Before ordering tests, your healthcare provider will review your medical history, perform a physical exam, and inquire about factors like family history of prostate problems, lifestyle habits, and the onset of symptoms.

To confirm whether you have benign prostatic hyperplasia and not prostate cancer, healthcare providers use several diagnostic tests. Here are the four best tests for diagnosing BPH.

A digital rectal exam (DRE) is often the first step in evaluating prostate health. During a DRE, your healthcare professional inserts a gloved, lubricated finger into your rectum to feel the size, shape, and texture of your prostate gland. This exam helps detect an enlarged prostate, lumps, or other abnormalities [6].

• Why it's important: A DRE can quickly assess whether prostate size enlargement is due to BPH or if there are signs suggestive of prostate cancer.
• What to expect: The exam is brief and may cause slight discomfort but provides valuable information about your prostate health, and aids in the treatment of benign prostatic hyperplasia.

The PSA blood test measures the level of prostate specific antigen in your blood. Elevated PSA levels can indicate BPH, prostate cancer, or prostatitis [5].

• Why it's important: While PSA levels naturally increase with age and prostate enlargement, significantly high levels may warrant further investigation, such as a prostate biopsy [6].
• Limitations: The PSA test alone cannot confirm benign prostatic hyperplasia; it's often used in conjunction with other tests [6].

A urinalysis checks for signs of urinary tract infection (UTI) or blood in the urine, which could indicate other conditions. Urine flow studies measure the speed and volume of urine expelled, helping assess the severity of urinary symptoms and prostatic enlargement [7].

• Why it's important: These tests help rule out infections or other causes of lower urinary tract symptoms and evaluate the impact of BPH on urine flow.

A transrectal ultrasound (TRUS) uses sound waves to create an image of the prostate [8]. If cancer is suspected, a prostate biopsy may be performed during the TRUS to collect tissue samples.

• Why it's important: TRUS helps measure prostate volume and detect abnormalities. A biopsy can confirm or rule out prostate cancer.
• What to expect: A probe is inserted into the rectum to capture images. If a biopsy is needed, a needle removes small samples of prostatic tissue for analysis.

Once diagnosed with BPH, your doctor may recommend different treatment options depending on the severity of your symptoms. Here are some of the most common treatments:

For men with mild BPH symptoms, simple lifestyle changes can make a significant difference [9]. These include:

• Reducing fluid intake before bed
• Limiting caffeine and alcohol consumption
• Avoiding fluids that irritate the bladder, such as carbonated beverages

Medications can help manage the symptoms of benign prostatic hyperplasia by relaxing the muscles of the prostate and bladder or shrinking the prostate gland. Common medications for BPH treatment include[6]:

• Alpha-blockers: Relax muscle fibres in the prostate and bladder neck to improve urine flow, a symptom that is associated with benign prostatic hyperplasia.
• 5-alpha reductase inhibitors: Shrink the prostate by inhibiting hormones responsible for prostate growth.
• Combination therapy for benign prostatic hyperplasia: Using both types of medications can be more effective for some men to improve BPH symptoms.

For moderate symptoms to severe BPH, minimally invasive procedures such as the Prostatic Urethral Lift procedure (PUL) or Laser Enucleation of the Prostate can relieve symptoms caused by BPH without removing large portions of the prostate tissue [6].

• Prostatic Urethral Lift (PUL): Places implants to hold the enlarged prostate tissue away from the urethra, improving urine flow without removing tissue.
• Transurethral Microwave Thermotherapy (TUMT) and Transurethral Needle Ablation (TUNA): Use heat to destroy excess prostate tissue.

For severe benign prostate hyperplasia, surgical treatment may be necessary [6]:

• Transurethral Resection of the Prostate (TURP): Removes part of the prostate tissue to relieve obstruction.
• Transurethral Incision of the Prostate (TUIP): Makes small cuts in the prostate to reduce urethral pressure.
• Laser Surgery: Techniques like Laser Enucleation of the Prostate or Photoselective Vaporisation of the Prostate use lasers to remove or vaporise excess tissue.

The most common surgical treatment for BPH is the transurethral resection of the prostate (TURP). This procedure involves removing part of the prostate that is blocking urine flow.

While BPH and prostate cancer both affect the prostate gland, having benign prostatic hyperplasia does not increase your risk of prostate cancer. However, because symptoms can be similar, it's crucial to undergo proper testing for accurate diagnosis.

Men with a family history of prostate cancer should discuss regular prostate cancer screening with their health care provider, as they may have an increased risk of prostate cancer.

If you're experiencing symptoms of benign prostatic hyperplasia or any urinary issues, it's important to consult a health care professional. Early diagnosis can lead to more effective management of benign prostatic hyperplasia and improve your quality of life.

Take control of your prostate health today—visit Mosh to speak with a Mosh practitioner and get your free prostate assessment.