Causes of error in diagnosing benign prostatic hyperplasia

The minimum requirements for a clinical diagnosis of benign prostatic hyperplasia are still being debated. With the exception of uroflowmetry and transrectal ultrasound (TRUS), which can be further investigated by means of pressure-flow studies or biopsy, the most frequent causes of diagnostic error are a mistaken interpretation of an abnormal increase in serum prostate-specific antigen (PSA) levels not due to neoplastic causes and/or the attempt to find a correlation between lower urinary tract symptoms (LUTS) and the presence of bladder outlet obstruction (BOO). The aim of this article is to describe the causes of non-neoplastic increases in serum PSA concentrations and to investigate the relationship between LUTS and BOO by means of an updated review of the literature. Serum PSA levels may be profoundly affected by a series of factors, including prostatitis, urinary retention, ejaculation, ambulation, cystoscopy, TRUS-guided biopsy, catheterisation and hemodialysis, and there are no standardised evaluation criteria as yet. Many authors have attempted to verify the relationship between LUTS and BOO, and it has recently been shown that the American Urological Association (AUA) symptom index, the Danish Prostate Symptom Score (DAN-PSS) and the International Continence Society "BPH" study are not related to BOO. In conclusion, it is clear that the quantification of BOO and LUTS are two different methods of measuring different aspects of prostatic enlargement, and that both should be considered separately. ©2001, Editrice Kurtis.