3.

What assessment and evaluation factors, diagnostic procedures, and imaging Techniques are
utilized to detect the disease?

Diagnosis of BPH

 Digital rectal examination

 should be considered for patients with symptoms or palpable prostatic
abnormalities.
 Urinalysis and urine culture
 Men with moderate or severe symptoms of obstruction may also have
uroflowmetry (an objective test of urine volume and flow rate) with measurement
of postvoid residual volume by bladder ultrasonography. Flow rate < 15 mL/sec
suggests obstruction, and postvoid residual volume > 100 mL suggests acute
retention.
 Prostate-specific antigen level
 Interpreting prostate-specific antigen (PSA) levels can be complex. The PSA level
is moderately elevated in 30 to 50% of patients with BPH, depending on prostate
size and degree of obstruction, and is elevated in 25 to 92% of patients with
prostate cancer, depending on the tumor volume.
 In patients without cancer, serum PSA levels > 1.5 ng/mL (1.5 mcg/L) usually
indicate a prostate volume ≥ 30 mL. If the PSA level is > 4 ng/mL (4 mcg/L),
further discussion/shared decision-making regarding other tests or biopsy is
recommended.
 For men < 50 or those at high risk of prostate cancer, a lower cutoff (PSA > 2.5
ng/mL [2.5 mcg/L]) may be used. Other measures, including rate of PSA increase,
free-to-bound PSA ratio, and other markers, may be useful.

Other testing

 Transrectal biopsy
  is usually done with ultrasound guidance (to minimize risk of infection) and is
usually indicated only if there is suspicion of prostate cancer. Transrectal
ultrasonography is an accurate way to measure prostate volume.
 Contrast imaging studies (e.g., CT, intravenous urography [IVU])
 are rarely necessary unless the patient has had a urinary tract infection (UTI) with
fever or obstructive symptoms have been severe and prolonged. Upper urinary
tract abnormalities that usually result from bladder outlet obstruction include
upward displacement of the terminal portions of the ureters (fish hooking),
ureteral dilation, and hydronephrosis. If an upper tract imaging study is warranted
due to pain or elevated serum creatinine level, ultrasonography may be preferred
because it avoids radiation and IV contrast exposure.
 Alternatively, men whose PSA levels warrant testing can undergo multipara metric
MRI
 which is more sensitive (although less specific) than transrectal biopsy.
Restricting biopsies to areas found to be suspect on multipara metric MRI may
reduce the number of prostate biopsies and diagnoses of clinically insignificant
prostate cancers, as well as possibly increasing diagnoses of clinically significant
prostate cancers.
 Cystoscopy
 may help determine the optimal surgical approach and to rule out other
obstructive causes such as strictures.

Reference:

Andriole, G. L. (2022, October 20). Benign Prostatic Hyperplasia (BPH). MSD Manual
Professional Edition. Retrieved October 22, 2022, from
https://www.msdmanuals.com/professional/genitourinary-disorders/benign-prostate-disease/
benign-prostatic-hyperplasia-bph