About this page. This is a plain English summary of how an enlarged prostate (BPH) is assessed before any treatment is chosen. It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
Why the assessment matters
An enlarged prostate is very common - around 1 in 5 men eventually have surgery for it at some point in life. The first job is to understand which symptoms you have, how much they bother you, and whether the bladder or kidneys have been affected. The assessment, not the prostate size by itself, decides the treatment.
The two types of symptoms
- Obstructive symptoms - the urine stream is hesitant, slow, or feels like it is not finished.
- Irritative symptoms - going often (frequency), needing to rush (urgency), and getting up at night (nocturia).
Some men also get repeated urine infections, blood in the urine, or sudden inability to pass urine (urinary retention).
Scoring how bad the symptoms are
You will usually be asked to fill in a short questionnaire (the IPSS or American Urological Association score). Seven questions, scored 0 to 5, give a total out of 35:
- 0 to 7 - mild symptoms.
- 7 to 18 - moderate symptoms.
- 18 to 35 - severe symptoms.
You fill it in independently of the doctor, so the answers are honest and consistent over time.
The tests
- Blood tests for kidney function and a PSA test to look for prostate cancer.
- Urine flow test - you pass urine into a special toilet that measures how fast and how much.
- Bladder ultrasound after passing urine, to see how much is left behind. A large amount left can be an early sign that the bladder is starting to fail.
- Urine test to rule out infection.
- Examination to feel the size of the prostate, and importantly to feel for any nodules that could mean prostate cancer.
- Urodynamics in some men - a pressure test where a small catheter is placed and the bladder is filled, to confirm the prostate is the cause of the blockage rather than the bladder.
Important things to know
- The size of the prostate is only part of the picture. Some large prostates cause no problems and need no treatment.
- If the bladder cannot empty fully for a long time, it can fail. Occasionally, the blockage can extend back to the kidneys. That is why the assessment includes the bladder and kidneys, not just the prostate.
- The PSA blood test is included because the prostate may also harbour cancer. A raised PSA does not always mean cancer, but it always deserves a careful look.
- The assessment guides treatment. The same person may need different treatments at different times of life.
What you can do next
- Read the full detailed page with references and patient brochures.
- Short version overview of an enlarged prostate.
- Short version: managing an enlarged prostate.
- Short version: surgical options.
- Request a second opinion on a treatment plan.
- Call 02 8382 6980 to make an appointment.