The clinical assessment of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the most common pathologic condition to afflict the aging male and the second most common cause of surgical intervention in men older than 60 years of age. Unfortunately, many men currently undergo prostatectomy without rigorous evaluation of their condition in terms of either transition zone hyperplasia or the extent to which this is causing bladder outflow obstruction.

In this review, the importance of symptoms and symptom scoring systems associated with bladder outflow obstruction due to BPH were considered as well as the use of prostate specific antigen (PBS), uroflowometry, and abdominal and transrectal ultrasound studies in addition to magnetic resonance imaging (MRI).

Patients undergoing surgical or non-surgical treatment for BPH should be studied by means of a formal symptom score, as well as repeated uroflowometry and abdominal ultrasound. PSA determination should also be made and those patients with values above 4 mg/ml should undergo transrectal ultrasound study and biopsy. Patients with values greater than 10 mg/ml should be considered for systematic biopsy whatever this reveals. MRI, with or without the new endorectal coil, is a promising tool for evaluation of the prostate, but more in a research than routine clinical context.