The prostate is part of the male reproductive system, is about the same size and shape as a walnut and weighs about an ounce. It is located below the bladder and in front of the rectum, and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce ejaculatory fluid.
Benign prostatic hyperplasia (BPH), formerly known as prostatism, is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. As the prostate enlarges, it can squeeze down on the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH. Risk factors for developing BPH include increasing age and a family history of BPH.
Since the prostate surrounds the urethra just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. A common symptom is the need to frequently empty the bladder, sometimes as often as every two hours or more, especially at night. Other symptoms include the sensation that the bladder is not empty, even after a man is done urinating, or that a man cannot postpone urination once the urge to urinate arises. BPH can cause a weak urinary stream, dribbling of urine, or the need to stop and start urinating several times when emptying the bladder. BPH can cause difficulty in starting to urinate, often requiring a man to push or strain in order to urinate. In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.
In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur. This helps measure how severe the BPH is — ranging from mild to severe.
When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the doctor will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the clinical situation. These include:
prostate specific antigen (PSA) - a PSA is an easy blood test used to screen for problems of the prostate. It measures how much of the protein called PSA is in your blood. Having a raised PSA level does not mean you have prostate cancer. Other reasons, such as infections or an enlarged prostate can cause high PSA levels.* (*from urologyhealth.org)
urinary cytology - a urine test to screen for bladder cancer
post-void residual volume (PVR) - a measurement of the amount of urine left in the bladder after urinating
uroflowmetry, or urine flow study - a measure of how fast urine flows when a man urinates
cystoscopy - a direct look in the urethra and/or bladder using a small flexible scope urodynamic pressure
flow study that tests the pressures inside the bladder during urination
ultrasound of the kidney or the prostate
A man should see a doctor if he has any of the symptoms mentioned previously that are bothersome. In addition, he should see a doctor immediately if he has blood in the urine, pain with urination, burning with urination or is unable to urinate.