The clinical diagnosis of<unk>  is based on a history of LUTS (lower urinary tract symptoms), a digital rectal exam, and exclusion of other causes of similar signs and symptoms. The degree of LUTS does not necessarily correspond to the size of the prostate. An enlarged prostate gland on rectal examination that is symmetric and smooth supports a diagnosis of<unk> . However, if the prostate gland feels asymmetrical, firm, or nodular, this raises concern for prostate cancer. Validated questionnaires such as the American Urological Association Symptom Index (AUA-SI), the International Prostate Symptom Score (I-PSS), and more recently the UWIN score (urgency, weak stream, incomplete emptying, and nocturia) are useful aids to making the diagnosis of<unk>  and quantifying the severity of symptoms. Laboratory investigations Urinalysis is typically performed when LUTS are present and<unk>  is suspected to evaluate for signs of a urinary tract infection, glucose in the urine (suggestive of diabetes), or protein in the urine (suggestive of kidney disease). Bloodwork including kidney function tests and prostate specific antigen (PSA) are often ordered to evaluate for kidney damage and prostate cancer, respectively. However, checking blood PSA levels for prostate cancer screening is controversial and not necessarily indicated in every evaluation for<unk> .<unk>  and prostate cancer are both capable of increasing blood PSA levels and PSA elevation is unable to differentiate these two conditions well. If PSA levels are checked and are high, then further investigation is warranted. Measures including PSA density, free PSA, rectal examination, and transrectal ultrasonography may be helpful in determining whether a PSA increase is due to<unk>  or prostate cancer. Imaging and other investigations Uroflowmetry is done to measure the rate of urine flow and total volume of urine voided when the subject is peeing. Abdominal ultrasound examination of the prostate and kidneys is often performed to rule out hydronephrosis and hydroureter. Incidentally, cysts, tumours, and stones may be found on ultrasound. Post-void residual volume of more than 100 ml may indicate significant obstruction. Prostate size of 30 cc or more indictes enlargement of the prostate. On transrectal ultrasound (TRUS),<unk>  calcifications can be seen. Calcifications is due to solidification of<unk>  secretions or calcified corpora amylacea (hyaline masses on prostate gland). Calcifications is also found in variety of other conditions such as<unk> is, chronic pelvic pain syndrome, and prostate cancer. For those with elevated levels of PSA, TRUS guided biopsy is performed to take a sample of the prostate for investigation. Although MRI is more accurate than TRUS in determining prostate volume, TRUS is less expensive and almost as accurate as MRI. Therefore, TRUS is still preferred to measure prostate volume. Differential diagnosis Medical conditions The differential diagnosis for LUTS is broad and includes various medical conditions, neurologic disorders, and other diseases of the bladder, urethra, and prostate such as bladder cancer, urinary tract infection, urethral stricture, urethral calculi (stones), chronic<unk> is, and prostate cancer. Neurogenic bladder can cause urinary retention and cause symptoms similar to those of<unk> . This may occur as a result of uncoordinated contraction of the bladder muscle or impairment in the timing of bladder muscle contraction and urethral sphincter relaxation. Notable causes of neurogenic bladder include disorders of the central nervous system such as Parkinson's disease, multiple sclerosis, and spinal cord injuries as well as disorders of the peripheral nervous system such as diabetes mellitus, vitamin B12 deficiency, and alcohol-induced nerve damage. Individuals affected by heart failure often experience nighttime awakenings to urinate due to redistribution of fluid accumulated in swollen legs. Medications Certain medications can increase urination difficulties by increasing bladder outlet resistance due to increased smooth muscle tone at the prostate or bladder neck and contribute to LUTS. Alpha-adrenergic agonist medications, such as decongestants with pseudoephedrine can increase bladder outlet resistance. In contrast, calcium channel blockers and anticholinergic medications can worsen urinary retention by promoting bladder muscle relaxation. Diuretic medications such as loop diuretics (e.g., furosemide) or thiazides (e.g., chlorthalidone) can cause or worsen urinary frequency and nighttime awakenings to urinate. File:Nodular<unk>  of the prostate.Micrograph showing nodular<unk>  (left off center) of the prostate from a transurethral resection of the prostate (TURP). H&E stain. File:Prostate histology.Microscopic examination of different types of prostate tissues (stained with immunohistochemical techniques): A. Normal (non-neoplastic)<unk>  tissue (NNT). B.<unk> . C. High-grade<unk>  intraepithelial neoplasia. D.<unk>  adenocarcinoma (PCA).
Benign prostatic hyperplasia
Prostate cancer
Chronic bacterial prostatitis
Heart failure
Acute prostatitis
Diabetes
Granulomatous prostatitis
Urinary bladder disease