How to Diagnose BPH

Benign prostatic hyperplasia (BPH), or an enlarged prostate, is a common condition that affects many men as they age, especially those over the age of 50. While BPH is not cancerous, it can lead to uncomfortable and potentially severe urinary symptoms that affect quality of life. Understanding how BPH is diagnosed is the first step in finding relief and preventing complications like urinary retention or bladder damage. 

At American Prostate Centers, we specialize in helping men identify and treat BPH using advanced, minimally invasive techniques. Here’s what you need to know about how BPH is diagnosed and what to expect during the process.

What is BPH?

The prostate is a small, walnut-shaped gland located below the bladder and in front of the rectum. It surrounds the urethra, the tube through which urine exits the body. As men age, the prostate gland can gradually enlarge, squeezing the urethra and interfering with urine flow. This noncancerous enlargement is known as BPH. 

Common symptoms of BPH include:

• Frequent urination, especially at night (nocturia)
• Difficulty starting urination
• Weak urine stream or a stream that stops and starts 
• Urinary incontinence 
• A feeling of incomplete bladder emptying
• Urgency to urinate 
• Dribbling at the end of urination

These symptoms can overlap with other urological conditions, so proper diagnosis is very important to determine if BPH is the cause and to rule out more serious concerns like prostate cancer.

How is BPH Diagnosed?

Diagnosing BPH involves a combination of medical history, physical examination, and diagnostic tests. Here’s a breakdown of urologists’ steps to confirm an initial BPH diagnosis.

1. Medical History and Symptom Assessment

Your diagnostic journey begins with a detailed review of your medical history and urinary symptoms. Your provider may ask:

• How often do you urinate during the day and night?
• Are you experiencing any discomfort or pain while urinating?
• Do you feel like your bladder is completely empty after urinating?
• Have you had any urinary tract infections?
• Are you taking any medications that could affect urination?

To evaluate the severity of the symptoms, you may be asked to complete the American Urological Association Symptom Index (AUA-SI). This brief questionnaire assesses the frequency and impact of your symptoms. This tool helps track changes over time and guides treatment decisions.

2. Digital Rectum Exam (DRE)

A Digital Rectum Exam (DRE) is a simple physical exam that allows the doctor to assess the size and texture of the prostate gland. During this exam, the doctor inserts a gloved, lubricated finger into the rectum to feel the back portion of the prostate. Although a DRE can’t confirm BPH on its own, it helps detect abnormal growths or hard areas that could indicate prostate cancer or other issues that require further evaluation.

3. Urinalysis and Blood Tests

Laboratory tests play an essential role in diagnosing BPH:

• Urinalysis: A urine sample can help rule out infections, blood in the urine, or other causes of urinary symptoms.
• Prostate-Specific Antigen (PSA) Test: This blood test measures the level of PSA, a protein produced by the prostate. Elevated PSA levels can be caused by BPH, prostate cancer, or prostatitis (inflammation of the prostate). While not specific to BPH, PSA levels provide helpful context in the diagnostic process.

4. Post-Void Residual (PVR) Test

A Post-Void Residual (PVR) test measures the amount of urine remaining in the bladder after urination. This test is typically performed using ultrasound. A significant amount of residual urine may suggest that the bladder is not emptying properly, which is often a common result of BPH.

5. Urinary Flow Test

Also known as uroflowmetry, this test measures the strength and amount of urine flow. You’ll be asked to urinate using a special device that records how quickly and how much urine is passed. A weak flow rate can point to trouble from an enlarged prostate.

6. Cystoscopy

Sometimes, if your symptoms are quite severe or if other tests haven’t provided clear answers, your doctor might recommend a cystoscopy. This procedure involves the use of a thin, flexible tube with a camera, known as a cystoscope, which is gently inserted through the urethra and into the bladder. This allows the doctor to take a closer look at what’s happening inside your urethra and bladder to check for any narrowing or blockages. Cystoscopy is usually done with local anesthesia to keep you comfortable and is especially useful in complicated cases or when surgery might be needed.

7. Pelvic MRI with and without Contrast

At American Prostate Centers, we utilize advanced imaging techniques to assess the size and condition of the prostate. One of the most effective tools is a pelvic MRI with and without contrast. This imaging test provides a detailed view of the prostate and surrounding tissues, helping us evaluate the degree of prostate enlargement and rule out other potential concerns.

If your urologist has already performed a recent pelvic MRI, we may use that imaging to assist in your diagnosis and treatment planning. If not, we can order one as part of your evaluation. Using MRI allows us to create a more accurate and personalized treatment approach, especially when considering advanced, minimally invasive procedures like prostate artery embolization (PAE).

Why Accurate Diagnosis of BPH Matters

Proper diagnosis of BPH ensures that patients receive the most appropriate care. Many treatment options are available, from lifestyle changes and medications to minimally invasive procedures. However, the best treatment depends on symptom severity, prostate size, and overall health.

Failing to treat BPH can lead to complications, including:

• Bladder stones
• Chronic urinary retention
• Urinary tract infections
• Kidney damage

Early diagnosis enables timely intervention and improved outcomes.

Discover Cutting-Edge Diagnosis and Treatment at American Prostate Centers in Queens!

At American Prostate Centers, we provide personalized care for diagnosing and treating BPH (benign prostatic hyperplasia). Our team utilizes the latest tools to identify the cause of your symptoms and develop a personalized treatment plan. We focus on minimally invasive options like prostate artery embolization (PAE), which can shrink the prostate without surgery and allows for a quick recovery. If you have BPH-related urinary symptoms, getting help early is important to protect your bladder health and improve your quality of life.If you live in or near Queens, NY, we can help. Our affiliated prostate center in Long Island City offers modern diagnostic and treatment options in a comfortable setting. Schedule an appointment today to find out if your symptoms are caused by BPH and learn how we can help you feel better.