1. Physical Examination by a Doctor, including:

Digital Rectal Examination (DRE): This important examination is conducted in patients with BPH. It helps estimate prostate enlargement, consistency, and the presence of nodules, which can be a sign of prostate cancer. Measuring prostate volume through DRE tends to underestimate the actual size. During the digital rectal examination, it is also necessary to assess the tone of the anal sphincter and bulbocavernosus reflex, which can indicate abnormalities in the reflex arc in the sacral region.

2. Diagnostic Tests include:

   a. Urinalysis: This test is done to determine the presence of leukocytes and blood in the urine. If hematuria is detected, further examination, such as urine culture, may be needed to identify a urinary tract infection. Urinalysis is necessary for diagnosing urinary symptoms in men, especially those complaining of painful urination.

   b. Prostate-Specific Antigen (PSA) Test:

      PSA is produced by the prostate gland and is organ-specific but not cancer-specific. PSA levels in the blood can increase due to inflammation, prostate manipulation (such as prostate biopsy or TURP), acute urinary retention, catheterization, prostate cancer, and age-related factors.

      Serum PSA can be used to predict the course of BPH. In this case, a high PSA level indicates that: (a) the prostate volume is growing faster, (b) BPH symptoms or urine flow rate worsen, and (c) there is a higher risk of acute urinary retention.

      Prostate volume growth can be predicted based on PSA levels. Higher PSA levels indicate a faster prostate growth rate. The average annual growth rate of prostate volume is 0.7 mL/year for PSA levels of 0.2-1.3 ng/mL, 2.1 mL/year for PSA levels of 1.4-3.2 ng/mL, and 3.3 mL/year for PSA levels of 3.3-9.9 ng/mL. PSA levels may increase during acute urinary retention and gradually decrease, especially after 72 hours of catheterization. PSA screening becomes crucial for detecting possible prostate carcinoma in individuals aged 50 and above or 40 and above (in high-risk groups). If PSA levels exceed 4 ng/mL, a prostate biopsy should be considered after discussion with the patient.

   c. Uroflowmetry (Urine Flow Test): This non-invasive test measures the rate of urine flow during urination. It is used to detect lower urinary tract obstruction symptoms. Uroflowmetry provides information about urine volume, maximum flow rate (Qmax), average flow rate (Qave), time taken to reach maximum flow rate, and voiding duration. The test helps evaluate infravesical obstruction symptoms, both before and after therapy. However, the results of uroflowmetry are not specific to the cause of abnormal urine flow. Weak urine flow can be caused by lower urinary tract obstruction or weak bladder muscle contractions.

d. Residual Urine Measurement:

Residual urine, or post-void residual urine (PVR), is the urine left in the bladder after urination. The average amount of residual urine in normal men is around 12 mL. Residual urine can be measured using methods such as ultrasound (USG), bladder scan, or urethral catheterization. Catheterization provides more accurate results than ultrasound, but it can be uncomfortable for the patient and carries the risk of urethral injury, urinary tract infection, and bacteremia. An increased volume of residual urine can be caused by lower urinary tract obstruction or weakness in the contraction of the detrusor muscle. A higher volume of residual urine during the initial examination is associated with an increased risk of symptom worsening. An increase in residual urine volume during regular monitoring is associated with the risk of urinary retention.

e. Prostate Imaging:

Prostate imaging is a routine examination aimed at assessing the shape and size of the prostate using transabdominal ultrasound (TAUS) or transrectal ultrasound (TRUS).

Author: Dr. Nurul Wijayanti (Medical Laboratory Service Doctor at PRAMITA Clinic, Jl. Parang Kusumo No. 2, Surabaya)