Can noninvasive evaluation of benign prostatic obstruction be optimized?

Lower urinary tract symptoms caused by benign prostatic obstruction is a common disorder and the incidence is increasing with higher life expectancy. The present article focuses on recently published methods to diagnose bladder outlet obstruction and differ between benign obstruction and prostate cancer in lower urinary tract symptoms patients.

Several new ultrasound imaging techniques have been reported. Resistive index in the prostatic artery, detrusor wall thickness and prostatic urethral angle all may correlate with obstruction, but more studies are needed to establish their place in clinical practice. Intravesical prostatic protrusion can predict obstruction and may be considered for clinical use. Near infrared spectroscopy has to be studied more to clarify its usefulness in clinical practice. There has been a rapid development of novel serum and urine-based biomarkers for prostate cancer in the last decade to differentiate between benign prostatic hyperplasia and prostate cancer. The recent studies with the use of prostate-specific antigen and urine prostate cancer gene 3 look promising.

Among promising new techniques in the investigation of prostatic obstruction, intravesical prostatic protrusion may be considered for clinical use. None of the methods described in recent studies can fully replace urodynamic investigation. Novel biomarkers in the future may help the clinicians to differentiate benign prostatic hyperplasia from prostate cancer.