If you have urinary symptoms, your GP or urologist will want to find out whether an enlarged prostate is the cause and how much it is affecting your bladder. Most of the tests involved are quick and simple. Knowing what each one does can make appointments feel more straightforward.
Your history and symptom score
Assessment starts with a conversation about your symptoms, general health, medicines and fluid habits. You will usually be asked to complete the International Prostate Symptom Score questionnaire. Our article on common BPH symptoms explains how it is scored.
You may also be asked to keep a bladder diary for a few days, recording drinks, trips to the toilet and the volume of urine passed.
Physical examination
The doctor will usually examine your abdomen to check whether the bladder is enlarged. A digital rectal examination allows the doctor to feel the size, shape and texture of the prostate. An enlarged but smooth gland is typical of BPH. A hard or irregular area may need further assessment.
Urine test
A urine sample is checked for infection, blood and sugar. Infection or diabetes can cause symptoms similar to BPH, so it is important to rule them out.
Blood tests
Two blood tests are commonly offered:
- Kidney function: to make sure the kidneys are not affected by pressure from a bladder that does not empty well.
- PSA: after discussing the pros and cons, as PSA can be raised by both BPH and prostate cancer. Our guide to the PSA test explains what a result means.
Urine flow test
A flow test, or uroflowmetry, measures how fast urine comes out. You pass urine into a special toilet or funnel connected to a machine. It records:
- the maximum flow rate
- the average flow rate
- the volume passed
- the shape of the flow pattern
A low maximum flow rate suggests something is blocking the outlet, often the prostate. It helps to arrive with a comfortably full bladder.
Bladder scan
After the flow test, a small ultrasound probe is placed on the lower abdomen to measure how much urine is left in the bladder. This is called the post-void residual. A large residual volume can increase the risk of infection and bladder problems.
Prostate ultrasound or MRI
An ultrasound scan, sometimes through the back passage, can measure the size and shape of the prostate. This is important when planning treatment, because some procedures suit particular prostate sizes. For example, Aquablation therapy can treat a wide range of sizes. If cancer is a concern, an MRI scan may be recommended instead.
Further tests in some cases
For some men, more detailed tests help:
- Cystoscopy: a thin camera is passed into the bladder to look at the urethra, prostate and bladder lining. It is often done under local anaesthetic.
- Urodynamics: pressure measurements inside the bladder during filling and emptying, to show whether the problem is a blockage or weak bladder muscle.
- Kidney ultrasound: if there are concerns about the kidneys.
NICE guidance on urinary symptoms in men sets out when these tests are recommended. The British Association of Urological Surgeons also publishes patient leaflets on each test.
Putting the results together
No single test diagnoses BPH, and you will not necessarily need every test listed here. Many men need only a few of the simpler checks before a clear plan can be made. Your urologist will combine the results with your symptom score and examination. This shows how much the prostate is affecting your flow, whether the bladder is under strain and which treatments are likely to suit you. Our page on benign prostatic enlargement explains the options.
Professor Prokar Dasgupta can arrange a full assessment of urinary symptoms at The London Clinic. Please contact the clinic to book a consultation.