Understanding Enlarged Prostate (BPH): Diagnosis, Evaluation & When to Seek Help

Taking Control of Men’s Health—One Symptom at a Time

Benign Prostatic Hyperplasia (BPH), commonly referred to as an enlarged prostate, is a non-cancerous condition that affects a significant percentage of men, particularly as they age. The prostate gland, which is about the size of a walnut at young age in men, sits just below the bladder and surrounds the urethra like a donut wrapped around a straw. As men grow older, this gland naturally enlarges—but in some, the growth can become problematic, compressing the urethra and leading to troubling urinary symptoms.

If you are waking up multiple times at night to urinate, noticing a weak or hesitant urine stream, or feeling like your bladder is not fully emptying, you might be experiencing enlarged prostate, as they clinically call Benign Prostatic Hyperplasia (BPH).

Remember it is a common problem, you are not alone—and more importantly, you do not have to suffer in silence. With advancement in medical technology there are new non-surgical ways to treat prostate issues without surgery.

Understanding how BPH is diagnosed and evaluated is the critical first step in getting the help you need.

Why Early Diagnosis of BPH Matters

While BPH itself is not cancerous or life-threatening, ignoring its symptoms can snowball into serious complications, including:

  • Recurrent urinary tract infections (UTIs)
  • Bladder stones
  • Chronic bladder dysfunction
  • Kidney damage
  • Acute urinary retention—a sudden, painful inability to urinate, often requiring emergency catheterization

Imagine your bladder as a balloon. If you keep inflating it without fully deflating (emptying), the walls stretch and weaken over time—eventually losing their elasticity and functionality. And though it is unlikely that prostate would burst like ballon, you should understand that inside the human body space is predefined and limited for each organ. If one organ expands it creates pressure on other organs affecting their functioning too.

Many men ignore the symptoms rejecting the same as old age issues however early diagnosis means broader treatment options, including non-surgical and minimally invasive procedures like Prostate Artery Embolization (PAE).

How Is BPH Diagnosed? A Step-by-Step Clinical Evaluation

Diagnosing BPH requires a comprehensive, structured approach that combines patient history, physical examination, lab tests, and—when necessary—imaging or advanced diagnostics. Here is how the process unfolds:

1.Medical History and Symptom Assessment

Your journey begins with a detailed discussion with your doctor. You will be given questions such as:

    • How often do you urinate during the day and night?
    • Do you experience urgency or straining?
    • Is the stream weak or interrupted?
    • Do you feel like your bladder is not fully empty?

The IPSS Questionnaire:

Most clinicians use the International Prostate Symptom Score (IPSS), a simple yet powerful 7-question brief questionnaire tool that classifies symptoms as mild, moderate, or severe.

2. Digital Rectal Exam (DRE)

While DRE sounds intrusive and uncomfortable exam, it is a very commonly performed OPD evaluation and is not as painful as it sounds; it is a straightforward physical exam:

    • The doctor inserts a gloved, lubricated finger into the rectum.
    • The prostate is felt through the rectal wall to assess size, texture, and firmness.

While not a definitive test, it helps spot warning signs such as Prostate enlargement, firm areas or nodules that might need cancer screening.

3. Urine Analysis and Flow Testing

Urine tests help rule out infections and other bladder problems that mimic BPH.

    • Urinalysis detects blood, infection, or abnormal cells.
    • Urine culture identifies specific bacteria, if infection is present.
    • Uroflowmetry measures how fast and how much urine flows—a key indicator of obstruction severity.

4. Blood Tests: PSA and Kidney Function

Blood tests provide deeper insights:

    • Prostate-Specific Antigen (PSA): Elevated levels can signal both BPH and prostate cancer. It is not conclusive, but it is a helpful marker.
    • Creatinine and other renal markers check for signs that your kidneys are under stress from urine backup.

5. Imaging Studies: Seeing Inside the System

If symptoms are severe or diagnosis remains uncertain, imaging tests help confirm the cause and evaluate severity:

    • Transrectal or abdominal ultrasound (Ultrasound of the Prostate) estimates the size of the prostate and checks for abnormalities like cysts or nodules.
    • Post-void residual volume (PVR): This is a scan or catheter-based test to measure how much urine remains in the bladder after you urinate. Measures how much urine remains after urinating—high volumes suggest poor bladder emptying.

6. Urodynamic Studies: Advanced Testing for Complex Cases

For treatment-resistant or unclear cases, urodynamic studies help assess:

    • Bladder pressure during filling and emptying.
    • Coordination between bladder muscles and the urethra

These tests help distinguish BPH from neurological conditions or bladder dysfunctions.

When to See a Specialist: Warning Signs You Should Not Ignore

You should consult a urologist or interventional radiologist if you experience:

  • Moderate to severe symptoms
  • No relief with medications
  • Elevated PSA levels
  • Recurrent UTIs or blood in the urine
  • Sudden inability to urinate (urinary retention)

When you are consulting with a Urologist, do check with the doctor if Prostate Artery Embolization (PAE) is a viable option for you and if not why? It is your right, and a simple query may save you from side effects of conventional prostate surgery.

Prostate Artery Embolization (PAE): A Modern, Minimally Invasive Option

What Is PAE?

Using advanced imaging, a catheter is inserted into the arteries supplying the prostate. Tiny microspheres are then delivered to block blood flow to the overgrown areas, causing them to shrink naturally over time.

PAE Benefits:

  • No general anesthesia
  • No surgical incisions
  • Minimal downtime and faster recovery
  • Preservation of sexual function in most men
  • Performed as a day-care or short stay procedure.

At Endovascular Clinic, we specialize in Prostate Artery Embolization (PAE) – a cutting-edge outpatient procedure performed by interventional radiologists.

Final Thoughts: Don’t Let BPH Control Your Life

The diagnosis and evaluation of BPH follow a logical, stepwise approach—starting with a discussion and ending with personalized treatment plans. If you are experiencing symptoms, do not chalk it up to “just aging.” Early evaluation opens the door to safer, more effective treatments, especially modern, non-surgical options like PAE.

At Endovascular Clinic, our team of highly trained interventional radiologists offers compassionate, expert care tailored to your needs.