Benign Prostatic Hyperplasia (BPH) is one of the most common conditions affecting older men. Diagnosis is usually made based on symptoms, a physical examination and some imaging studies.

The steps involved in diagnosing BPH include:

• A detailed history of the symptoms and any similar conditions among first-degree male relatives (such as father and brothers) is obtained. Patients may be asked to maintain a voiding chart to record their urine flow.
• The International Prostate Symptom Score (IPSS) is a scoring system used to screen for and diagnose benign BPH as well as to monitor symptoms and guide decisions about how to manage the disease. The IPSS is based on the answers to eight questions, seven regarding the patient’s symptoms and one relating to their perceived quality of life.
• For each of the symptom questions, the patient is asked to choose the rating that best represents their condition. The scale ranges from 1 to 5, with 5 representing the most symtpomatic disease and giving an overall maximum possible score of 35. The answers to the quality of life question are scored on a scale of 1 to 6.

The questions about symptoms ask the patient to report on their experience of the following during the past month:

• how often the bladder has felt like it s not completely emptied
• how often there is an urge to urinate less than two hours after the last time
• how often the flow has stopped and started again
• how often it is difficult to withhold from urinating
• how often the stream of urine is weak
• how often urinating is a strain
• how often one needs to get up at night to urinate

The combined score is obtained to give an idea of the extent of BPH, with a score of 0 to 7, representing mild symptoms, 8 to 19 moderate symptoms and 20 to 35 severe symptoms.

• Routine urine tests are performed to rule out other conditions such as urinary tract infection
• A digital rectal examination is performed by a healthcare professional who feels the prostate through the wall of the rectum to check it for abnormalities. If the gland has grown in size, the enlargement may be felt with the index finger, since the prostate lies just in front of the rectum. The procedure is not usually painful but can be a bit uncomfortable. In BPH, the enlargement feels smooth and firm.
• A blood test to measure levels of prostate specific antigen (PSA) is performed. PSA is a protein that is secreted by the prostate gland. PSA is normally present in the blood but the level normally increases with age and is significantly increased in cases of BPH.
• A transrectal ultrasound scan uses ultrasound waves to generate an image of the prostate gland.