To find out whether your prostate gland is enlarged, you'll need to have a few tests.

Some tests will be carried out by your GP and others will be carried out by a urologist (a doctor who specialises in urinary problems).

First, your GP will ask about your symptoms. If it seems that you have symptoms of benign prostate enlargement, the next stage is to calculate your International Prostate Symptom Score (IPSS).

International Prostate Symptom Score (IPSS)

You'll be asked to complete a questionnaire to assess your symptoms. Each question has five possible answers that carry a score, and your overall score is used to assess the severity of your symptoms.

The checklist includes the following questions.

Over the past month:

• How often have you had the sensation of not completely emptying your bladder after urinating?
• How often have you had to urinate again less than two hours after finishing urinating?
• How often have you found that you stopped and started again when urinating?
• How often have you found it difficult to postpone urination?
• How often have you had a weak stream of urine?
• How often have you had to push or strain to begin urinating during the course of one night?
• How often have you had to get up during the night to urinate?

After your GP has assessed the severity your symptoms, they'll aim to rule out other conditions with similar symptoms using certain tests.

Ruling out other conditions

The symptoms of benign prostate enlargement are similar to those of other conditions, including prostate cancer. Therefore, your GP will need to be completely sure that your symptoms aren't caused by cancer.

Urine tests

A urine test can be used to check whether your symptoms are caused by an infection in your urinary system, such as a kidney infection or bladder infection.

Rectal examination

You may need a rectal examination to check whether you might have prostate cancer. Prostate cancer can cause the prostate gland to become hard and bumpy.

Your GP will put on a glove and lubricate one of their fingers, before gently pushing this finger into your bottom and up into your rectum. As the rectum is close to the prostate gland, they'll be able to check whether the surface of the gland has changed. The procedure will feel a little uncomfortable, but it isn't usually painful.

Prostate cancer doesn't always cause changes to the prostate gland, so you may need to have some more specialised tests to rule it out. You will probably be referred to a urologist for these tests.

Prostate-specific antigen (PSA) test

A blood test can be used to measure the amount of the PSA protein that's produced by the prostate.

A raised PSA level indicates enlargement of the prostate, and a significantly raised level may indicate prostate cancer. However, as with a rectal examination, a PSA test can't provide a definitive diagnosis of prostate cancer.

Transrectal ultrasound (TRUS)

A TRUS is a type of ultrasound scan specifically designed to study the prostate and the surrounding area.

An ultrasound probe is placed into your rectum and uses soundwaves to build a detailed image of your prostate.

This type of scan measures the size of your prostate and can be used to either confirm or rule out a diagnosis of prostate cancer.

Computer tomographic (CT) urogram

A CT urogram is used to study the urinary tract (the bladder and the tubes through which urine passes, also known as the ureter and urethra).

A CT urogram can be used to check for blockages in your urinary system that could be causing your symptoms, such as a kidney stone or bladder stone. It can also be used to detect any damage in the urinary tract.

During a CT urogram, you’ll be injected with a harmless radioactive dye, which will be visible on X-rays. After 30-60 minutes, the dye should have passed into your urinary tract and a series of X-rays will be taken. In some cases, you may be asked to pass urine before the final X-ray is taken.

Voiding charts

A voiding chart is a urination diary, which you may be asked to keep for 24 hours. You'll be asked to record how often you urinate, as well as details about how you urinate – for example, whether your urination is stopping and starting, or whether it's difficult to start urinating.

A voiding chart is a good way of finding out more information about your symptoms and can be used to determine the type of treatment that would be most effective in controlling your symptoms.

Uroflowmetry

Uroflowmetry measures the pressure of your bladder and how well your bladder works when you urinate.

You'll be given a local anaesthetic and a small flexible tube (catheter) will be inserted into your urethra and moved up into your bladder.

Water will then be injected through the catheter and into your bladder. A computer connected to the catheter measures the pressure inside your bladder and can assess how well your bladder is working.

As with voiding charts, uroflowmetry is a good way of determining what type of treatment will help to control your symptoms.