Many symptoms of BPH result from blockage of the urethra and gradual loss of bladder function with incomplete emptying of the bladder. Though symptoms vary, the most common ones involve problems with urination: a hesitant, interrupted, weak urine stream, urgency and leaking or dribbling, more frequent urination, especially at night.
Interestingly, the size of the gland does not always determine how severe the symptoms will be. Some with greatly enlarged glands have few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.
Occasionally, an individual may not know he has any obstruction until he is suddenly unable to urinate at all. This so-called "acute urinary retention," may be triggered by over-the-counter cold or allergy medicines that contain a decongestant drug known as a "sympathomimetic." Such drugs can prevent the bladder opening from relaxing. If there is a partial obstruction, retention can also can be precipitated by alcohol, cold temperatures, or a long period of immobility.
In eight out of 10 cases, symptoms like those above suggest BPH. However, they can also signal other, more serious conditions. These conditions, including prostate cancer, can be ruled out only by a urologist's examination.
Over time, severe BPH can cause serious problems. Urinary retention and bladder strain may lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence. If the bladder is permanently damaged, treatment for BPH may prove ineffective. Finding BPH early lowers the risk of developing such complications.
Patients sometimes notice symptoms of BPH themselves, while in other cases, the doctor finds that the prostate is enlarged during a routine exam. When BPH is suspected, you may be referred to a urologist. Several tests will help him/her identify/characterize the problem and decide if surgery is needed. The tests chosen can vary, but among the most common are:
Digital Rectal Examination (DRE) The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This gives the doctor a general idea of the size and condition of the gland.
Prostate-Specific Antigen (PSA) Blood Test To rule out cancer as a cause of the symptoms, the doctor will likely recommend a "PSA" blood test. PSA (prostate specific antigen), is a protein produced by prostate cells, elevated levels are frequently seen in men with prostate cancer. While the FDA has approved a PSA test for use in conjunction with digital rectal examination to help detect prostate cancer, much remains unknown about the interpretation of PSA levels. There are limitations on the test's ability to discriminate between cancer and benign prostate conditions.