How is an enlarged prostate diagnosed?

You might have several different tests to find out if you have an enlarged prostate. Some of the tests can be done at your GP surgery. Your GP might also arrange for you to see a doctor who specialises in urinary problems (a urologist) or a specialist nurse at the hospital.

You may not need all of the tests described below. Ask your GP to explain which tests you will have, where you will have them, and what they will involve. Or call our specialist Nurses for more information.

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What tests might I have at the GP surgery?

Symptom check

Your GP will ask about your symptoms, how long you’ve had them, whether they are getting worse over time, and how they are affecting your life.

Before you visit your GP, you might want to think about how often you’ve had symptoms over the last month. This may help you explain your symptoms to your GP. You might also want to keep a diary of how much you drink and how often you urinate.

Your GP will check whether your symptoms might be caused by another health problem, such as diabetes, or by any medicines you are taking, such as blood pressure medicines, anti-depressants or herbal medicines.

They will also check whether your symptoms could be caused by your lifestyle – for example, if you often drink large amounts of fluid, alcohol, or drinks containing caffeine (such as tea, coffee or cola).

Bladder diary

Your GP may ask you to keep a diary for a few days to check how much you are drinking, what type of drinks you have, how much urine you pass, and how often and at what times you urinate. A diary can help your doctor to work out what may be causing your symptoms and how to treat them.

Urine test

Your GP may ask you for a urine sample to check for blood or any infection that could be causing your symptoms. You may need to give more than one sample. If you have an infection your GP will give you a course of antibiotics.

Blood tests

You may be offered a blood test to check your kidneys are working properly. You may also be offered a prostate specific antigen (PSA) blood test. PSA is a protein produced by cells in your prostate. If the PSA level is raised, there may be a problem with your prostate. An enlarged prostate can cause the amount of PSA in your blood to rise. A urine infection, inflammation and prostate cancer can also make your PSA level rise.

Physical examination

Your GP may examine your abdomen (stomach area) and penis. They may also feel your prostate through the wall of the back passage (rectum). This is called a digital rectal examination (DRE).

What tests might I have at the hospital?

If you’re given an appointment with a hospital specialist, they may do some of the tests you had at the GP surgery again. You may also have other tests, including the tests described below.

Symptom questionnaire

You might be asked to fill in a short questionnaire about your symptoms. This is called the International Prostate Symptom Score (IPSS) and is used to see how bad your symptoms are and how much they are bothering you.

Urine flow test

You’ll be asked to urinate into a machine that measures the speed of your urine flow. Men with an enlarged prostate usually have a slower flow than other men. You'll need a full bladder for the test. The doctor or nurse will tell you how much to drink before you have the test. They may also ask you not to urinate for two to three hours before the test.

Pelvic ultrasound scan

This shows how much urine your bladder can hold, and if it is emptying properly. You may have the scan straight after the urine flow test to see how much urine is left in your bladder after you urinate. You may also have an ultrasound scan to look at your kidneys.

Further tests for an enlarged prostate

Depending on your test results, you may have further tests to find out what is causing your symptoms.

Bladder pressure (urodynamic) test

This shows how well your bladder is working. The doctor passes thin tubes (catheter) up your penis and fills your bladder with fluid. A catheter is also placed in your back passage. An anaesthetic gel will be used when inserting catheters to make it more comfortable for you.  The catheter measures the pressure in your bladder, back passage, and urethra. You will then be asked to empty your bladder, and the pressure will be measured again while you urinate.

You may have this test if you’re thinking about having surgery to treat an enlarged prostate, or if you’ve had surgery but your symptoms haven’t improved or are getting worse.

Flexible cystoscopy

This shows whether you have a blockage or any abnormal tissue in your urethra or bladder. A doctor or specialist nurse will pass a thin tube up your penis into your bladder. You’ll be able to feel the tube moving, but anaesthetic gel will be used to make the test more comfortable. The tube has a light and camera on the end so the doctor or nurse can see the inside of your urethra and bladder on a screen.

You may have this test if you have severe urinary symptoms, blood in your urine or pain, or if you often get urine infections. You may also have this test if your doctor thinks your urethra or the opening of your bladder may be too narrow – this is called a stricture.

References

Updated: May 2022 | Due for Review: May 2025