Benign prostatic hyperplasia (BPH)—also known as benign prostatic enlargement (BPE) or an enlarged prostate—is the most common benign (noncancerous) growth process in men. An accurate diagnosis is important; some reports indicate that up to 30 percent of men who undergo surgery for BPH are found not to have prostate obstruction (meaning their symptoms were caused by something other than BPH).
To make the diagnosis, a careful medical history, a physical examination, and laboratory tests are required to exclude conditions such as narrowing of the urethra (urethral stricture) and bladder disease. Following are lab tests your doctor may order:
- Urinalysis—examination of a urine sample under a microscope—is performed in all patients who have lower urinary tract symptoms. Urinalysis is often the only laboratory test needed when symptoms are mild and the medical history and physical examination suggest that there are no other abnormalities.
- A urine culture (an attempt to grow and identify bacteria in a laboratory dish) is performed when a urinary tract infection is suspected. In the presence of severe or chronic symptoms of BPH, blood tests to detect abnormalities in creatinine, blood urea nitrogen, and hemoglobin are used to rule out the presence of kidney damage or anemia.
- A prostate-specific antigen (PSA) test is recommended for select men. PSA values alone are not helpful in determining whether symptoms are due to BPH or prostate cancer because both conditions can cause elevated levels.
The American Urological Association (AUA) recommends a PSA test if the test result could change the management of urinary symptoms. Knowing a man’s PSA level may help predict how rapidly his prostate will increase in size over time and whether problems such as urinary retention are likely to occur. For a man who does not have bothersome symptoms and in whom no intervention is anticipated, whether or not to measure PSA should be an individual decision made once he understands the potential benefits and harms of testing. And, for a man with bothersome symptoms, PSA testing is recommended prior to any intervention since the finding of prostate cancer could alter management of BPH.