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Initial diagnosis of Lower Urinary Tract Symptoms (LUTS)
Overview by Professor Richard Hindley
Consultant Urologist
University College London Hospitals and
Hampshire Hospitals NHS Foundation Trust
Typically for the initial diagnosis of prostate disease, or LUTS, we use the International Prostate Symptom Score (IPSS) to gauge the symptoms, along with a physical examination (including a digital rectal exam or DRE). In addition, we will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for LUTS depending on the clinical situation.
These include:
- Prostate specific antigen (PSA) – a blood test to screen/ exclude prostate cancer
- Urinary cytology – a urine test to screen/exclude for bladder cancer
- A measurement of post-void residual volume (PVR) – the amount of urine left in the bladder after urinating
- Uroflowmetry, or urine flow study – a measure of how fast urine flows when you urinate
- Cystoscopy – a direct look in the urethra and/or bladder using a small flexible scope
- Urodynamic pressure – flow study that tests the pressures inside the bladder during urination
- Ultrasound of the kidney or the prostate
The studies determine the diagnosis, which may be
- Urinary tract infection (UTI) – typically treatable with a course of anti-biotics
- Benign Prostatic Hyperplasia (BPH)
- Chronic prostatitis
- Bladder
- Urinary stone
- Neurological diseases such as Multiple Sclerosis (MS), spinal cord injury and disease.
International Prostate Symptom Score (IPSS)
The IPSS is an eight question, (7 symptom and 1 quality of life) questionnaire used to derive a score (0-35) and determine the management of Benign Prostatic Hyperplasia (BPH), which is the most common prostate problem. You can determine your IPSS online using the link on this page. There are various treatment options for BPH which you can explore on this site as well as Urologists that provide them
Typically a score of 0-7 indicates mild symptoms, 8-19 moderate symptoms and 20-35 severe symptoms. Higher scores indicate more severe symptoms. Scores less than seven are considered mild and generally do not warrant treatment. Regardless of your score, if your symptoms are bothersome, you should consult with your doctor.
What if your Prostate Specific Antigen (PSA) is raised – Does this mean prostate cancer?
What is a raised Prostate Specific Antigen (PSA) level ?
PSA is an enzyme found in a man’s blood produced exclusively by prostate cells. Its function is to make semen become more liquid. PSA is produced exclusively by epithelial prostatic cells, both benign and malignant.
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml).
If you are aged 50 to 59, a PSA lower than 2ng/ml is normal higher is abnormal. If you are aged 60-69, a PSA lower than 3ng/ml is normal, higher is abnormal
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that is not cancer, such as:
- Enlarged prostate or BPH, discussed above
- Prostatitis
- Urinary infection
How accurate is the PSA test ?
About 15 out of every 100 men with a normal PSA level have prostate cancer.
About 75 out of every 100 men with a raised PSA level do not have prostate cancer.
However – most men over 60 have some cancerous cells, which cause them no harm.
Pros and cons of the PSA test
Pros:
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early PSA testing may reduce your risk of dying if you do have cancer.
- If you have a family history of Prostate Cancer, this particularly means if your father or a brother has had Prostate Cancer, your chances of also getting Prostate Cancer are higher than if no one in your family has had it and it is very advisable to be tested.
- If you are of black ethnic origin, or are overweight or obese: these have increased risk factors for Prostate Cancer
- More information can be found in the Genetics and Prostate cancer page
Cons:
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- It may make you worry by finding a slow-growing cancer that may never cause any problems
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