Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:
- Digital rectal exam. The doctor inserts a finger into the rectum to check your prostate for enlargement.
- Urine test. Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
- Blood test. The results can indicate kidney problems.
- Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.
- Neurological exam. This brief evaluation of your mental functioning and nervous system can help identify causes of urinary problems other than enlarged prostate.
After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These additional tests might include:
- Urinary flow test. You urinate into a receptacle attached to a machine that measures the strength and amount of your urine flow. Test results help determine over time if your condition is getting better or worse.
- Postvoid residual volume test. This test measures whether you can empty your bladder completely. The test can be done using ultrasound or by inserting a catheter into your bladder after you urinate to measure how much urine is left in your bladder.
- 24-hour voiding diary. Recording the frequency and amount of urine might be especially helpful if more than one-third of your daily urinary output occurs at night.
If your condition is more complex, your doctor may recommend:
Nov. 13, 2014
- Transrectal ultrasound. An ultrasound probe is inserted into your rectum to measure and evaluate your prostate.
- Prostate biopsy. Transrectal ultrasound guides needles used to take tissue samples (biopsies) of the prostate. Examining the tissue can help your doctor diagnose or rule out prostate cancer.
- Urodynamic and pressure flow studies. A catheter is threaded through your urethra into your bladder. Water — or, less commonly, air — is slowly injected into your bladder. Your doctor can then measure bladder pressure and determine how well your bladder muscles are working.
- Cystoscopy. A lighted, flexible cystoscope is inserted into your urethra, allowing your doctor to see inside your urethra and bladder. You will be given a local anesthetic before this test.
- Intravenous pyelogram or CT urogram. A tracer is injected into a vein. X-rays or CT scans are then taken of your kidneys, bladder and the tubes that connect your kidneys to your bladder (ureters). These tests can help detect urinary tract stones, tumors or blockages above the bladder.
- Cunningham GR, et al. Epidemiology and pathogenesis of benign prostatic hyperplasia. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- Hanno PH, et al. Penn Clinical Manual of Urology. 2nd ed. Philadelphia, Pa.: Saunders Elsevier, 2014. http://www.clinicalkey.com. Accessed Aug. 28, 2014.
- Cunningham GR, et al. Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- Cunningham GR, et al. Transurethral procedures for treating benign prostatic hyperplasia. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- AskMayoExpert. What symptoms are associated with benign prostatic hyperplasia (BPH)? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Ferri FF. Ferri's Clinical Advisor 2015. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Aug. 27, 2014.
- Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.clinicalkey.com. Accessed Aug. 28, 2014.
- Parsons JK, et al. Obesity and benign prostatic hyperplasia: Clinical connections, emerging etiological paradigms and future directions. Journal of Urology. 2013;189:S102.
- AskMayoExpert. What are the usual indications for benign prostatic hyperplasia (BPH) surgery? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Cunningham GR, et al. Medical treatment of benign prostatic hyperplasia. http://www.uptodate.com/home. Accessed Aug. 27, 2014.
- AskMayoExpert. What types of benign prostatic hyperplasia (BPH) surgery are available? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Jaeger CD, et al. Holmium laser enucleation and photoselective vaporization of the prostate for patients with benign prostatic hyperplasia and chronic urinary retention. British Journal of Urology International. In press. Accessed Aug. 27, 2014.
- Mmeje CO, et al. Age-stratified outcomes of holmium laser enucleation of the prostate. British Journal of Urology International. 2013;112:982.
- Klett DE, et al. Patient-reported sexual outcomes after holmium laser enucleation of the prostate: A 3-year follow-up study. Urology. 2014;84:421.
- Krambeck AE, et al. Effectiveness of medical and surgical therapies for lower urinary tract symptoms in the community setting. British Journal of Urology International. 2012;110:1332.
- Pizzorno JE, et al. Textbook of Natural Medicine. 4th ed. St. Louis, Mo.: Churchill Livingstone Elsevier; 2013. https://www.clinicalkey.com. Accessed Aug. 27, 2014.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. July 14, 2014.
- Castle EP (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Sept. 15, 2014.
- Broderick GA (expert opinion). Mayo Clinic, Jacksonville, Fla. Sept. 25, 2014.