Benign Prostatic Hyperplasia (BPH)
Symptoms of BPH (eg, weak stream, urinary hesitance, incomplete emptying, etc.) are usually related to obstruction of the urinary tract. Severity of the symptoms can be measured using the American Urological Association Symptom Index (AUASI), a widely used questionnaire that quantifies the severity of lower urinary tract blockage symptoms (Sarma 2012). The International Prostate Symptom Score, or IPSS (Zhang 2008), is another questionnaire often used for quantifying symptoms of BPH in research studies.
The first step in evaluating patients with BPH-related symptoms includes a complete overview of the patient’s general medical, neurological, and urological history, as well as their fluid and caffeine consumption, to rule out other causes of urinary tract symptoms. Medications should also be reviewed, since diuretics and antihistamine drugs may cause urinary symptoms (Sarma 2012).
Next, a digital rectal exam (DRE) is performed and PSA levels are measured (Sarma 2012). PSA levels are important because while BPH is associated with some elevation of PSA levels, a very high or quickly-rising PSA level can be a sign of prostate cancer. For example, in one study, the median PSA value in patients with BPH was 1.8 ng/mL, whereas the median PSA value among patients with prostate cancer was 13.2 ng/mL (Lakhey 2010). Still, PSA levels are not a perfect measure since levels can be normal in men with prostate cancer. Therefore, the DRE (digital rectal exam) is also important, both to help rule out prostate cancer (a smooth prostate accessible by rectal examination is less likely to be cancerous than one with hard nodules and irregularities) and to determine the size of the prostate. Classification of the prostate size as “normal,” “big,” and “very big” can help determine therapy. Measuring urine flow rates using uroflowmetry can also help assess bladder outflow obstruction (McNicholas 2008). Additional testing such as free PSA and PSA velocity also help to differentiate BPH from prostate cancer. For more information see the Life Extension Magazine article entitled “Life Saving Advances in Prostate Cancer Testing”.