DIAGNOSIS OF ENLARGED PROSTATE ( BPH )

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   1. How is prostate enlargement diagnosed?

The aim is to confirm that the prostate is the main cause of your symptoms and to exclude other problems such as stones, tumours or bladder nerve disorders.

Common assessments include:

Symptom assessment

• Discussion about your urinary symptoms

• Often a questionnaire such as the International Prostate Symptom Score (IPSS) to rate severity and impact on quality of life

Physical examination

• General examination

• Abdominal examination to feel for a full bladder

• Digital rectal examination of the prostate

Urine tests

• Standard urine dipstick or laboratory test to look for infection, blood, sugar and protein

Blood tests

• Kidney function tests (urea and creatinine)

• PSA where appropriate

Ultrasound scan

• To check the kidneys, bladder and prostate

• To see whether you are leaving a significant amount of urine behind in the bladder after passing water (post-void residual)

Additional tests in selected cases:

• Uroflowmetry – a test that measures how fast your urine flow is

• Urodynamics – more specialised tests to study bladder function and pressures, used in complex cases

Not every man needs every test. The exact work-up is tailored to your symptoms, risk factors and general health.

2. Does every enlarged prostate need treatment?

No. Treatment decisions are based on:

• How severe your symptoms are

• How much they affect your quality of life

• Whether your bladder and kidneys are at risk

Treatment may not be needed if:

• Symptoms are mild and do not bother you very much

• Kidney function is normal

• You are emptying the bladder reasonably well

• There are no repeated infections, stones or bleeding

In these cases, a “watchful waiting” approach may be used, with:

• Lifestyle advice

• Regular monitoring

• Starting treatment only if and when things worsen

Treatment is more often recommended if:

• Symptoms are moderate or severe and affect daily life

• Tablets are not helping enough

• You have had urine retention (inability to pass urine)

• You have repeated infections, bladder stones or bleeding

• There is a significant amount of urine left in the bladder

• Kidney function is starting to suffer