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The symptoms of an enlarged prostate can look like the symptoms of more serious conditions, such as prostate cancer. Your doctor may do some, or all, of these tests to find out for sure what's causing your symptoms. But for some of these tests you will need to see a specialist in a hospital.

Here's an overview of the tests and examinations you may have.

Your doctor may ask you general question about your health and about any past illnesses, operations or treatments you've had. Your doctor may then ask you about any problems you're having urinating, such as a weak stream of urine or having to get up at night to use the bathroom.

Your doctor will also ask you about any medications you are taking, both prescription drugs and over-the-counter medications. This is because some drugs (such as antidepressants) can affect the way your bladder works. Next, your doctor will probably do a physical examination of your prostate. This is called a digital rectal examination.

Because your prostate is inside your body, your doctor cannot look at it directly. But he or she can feel it by putting a gloved and lubricated finger into your rectum. Your doctor can feel if your prostate is enlarged, has lumps on it, or feels strange in some other way. Your doctor may be able to feel lumps that are bigger than half an inch (around 1.5 centimeters). However, smaller lumps are easy to miss.

This exam can be a little bit uncomfortable, and some men find it embarrassing. But it's not usually painful and takes just a few minutes. Your doctor may also feel the lower part of your belly to see if he or she can feel your bladder. If your doctor can feel your bladder, it may not be emptying properly.

As part of a routine health check, your doctor may advise you to have a blood test that can pick up early prostate cancer. This test measures the amount of a substance called prostate-specific antigen, or PSA, in your blood. Your test results will show your level of PSA in a measurement of nanograms (ng) per milliliter (ml) of blood.

Your prostate produces PSA to keep your semen as a liquid. (Semen is the name given to your sperm and the fluid they are carried in.) When cancer is present, more PSA may seep from your prostate into your blood. But you can also have a high level of PSA if you have an enlarged prostate.

There are a lot of unanswered questions about PSA testing. When it's used with a digital rectal examination, it can help detect prostate cancer. But it cannot tell you for certain if you have cancer. It can only tell you what your chance of having it is.

For example, most men have a PSA level under 4 nanograms per milliliter of blood. If your level is above 4, but less than 10, your chance of having prostate cancer is about 1 in 4. The higher your PSA level is, the greater your chance of having prostate cancer. If your level goes above 10, your chance of having prostate cancer is more than 1 in 2.

But there are problems with the test. For example, PSA levels go up naturally as you get older, even if your prostate is normal. And other things, such as sexual activity, also can push it up. So the results of PSA tests are not always clear. If your PSA level is raised, your doctor may advise you to have other tests to find out what has made it go up.

Another problem is that doctors don't always know what to do if they find a high PSA level. We don't know if finding and treating prostate cancer early will improve your chances of surviving it.¹ The research is mixed. Some studies say one thing and some say another. Also, some tumors that are found by a PSA test are not a problem. They do not cause any symptoms or health problems if they're left just where they are and are never treated. It is often hard to tell whether a tumor is a harmful one or a harmless one.

You will be asked to urinate into a special container, and this sample will then be checked for infection or blood. Having an infection can cause you to need to urinate a lot, just like BPH can. Blood in the urine (called hematuria) can be a sign of bladder cancer, but it's also common in men with an enlarged prostate. If you have blood in your urine, you should see a urologist. A urologist is a doctor who deals with the male sex organs and the urinary tracts (the system of tubes that carry urine from your bladder to outside your body) of men and women.²

Your doctor may also test your urine or your blood to see how much creatinine they contain. Creatinine is a protein that's made naturally by your body. The amount of creatinine in your urine or blood shows how your kidneys are working. Your kidneys are the pair of organs that remove waste products from your blood and produce urine. If you have symptoms of an enlarged prostate, your chances of having kidney problems are slightly raised.³ Although these problems are rare, your doctor will want to catch any abnormalities early. This is why you'll probably be given this test when you first come to your doctor with symptoms.

This is the main test doctors use to find out for certain whether you have prostate cancer. Your doctor will use a special needle to remove a very small piece of tissue from your prostate. The needle is either gently pushed through the wall of your rectum into your prostate or it is put into the skin between your scrotum (the sac that holds your testicles) and your anus (the opening with which you empty your bowels). The needle is guided by a special device called an ultrasound probe. A biopsy is not usually painful, but you may feel a sharp prick, even if you are given a local anesthetic (painkiller) to numb the area.

A doctor then looks at the tissue from the biopsy under a microscope. If cancer cells are present, the more abnormal these cells look compared with healthy prostate cells, the more aggressive and likely to spread the cancer may be.

This test measures how quickly or slowly you urinate. All you have to do is urinate into a special device. You then get a score, called a Qmax rating, which tells you the fastest speed that your urine flows. A low Qmax rating suggests your urine flow is restricted and you may have an enlarged prostate.

This test measures the amount of urine left in your bladder after you've finished urinating. The test is very straightforward and completely painless. After you've used the bathroom, a scanner is passed over your belly where your bladder is. If the scanner shows there's urine left in your bladder, it may mean you have an enlarged prostate. You may also be at higher risk of getting an infection in your bladder.

This test measures the force (or pressure) in your bladder when you urinate. It's used to see if there's any blockage in your bladder. A small tube is inserted into your bladder through your penis to measure the pressure. This can be uncomfortable, which is why this test is usually used only in patients who can't be diagnosed with other tests.

Your doctor may recommend that you have an ultrasound scan of your lower body. This is similar to the scan given to pregnant women to see images of their developing baby. The ultrasound can show if your prostate gland is enlarged or abnormal, and whether any urine is left in your bladder after you've urinated. The scan is not painful or unpleasant.

For this test, a special probe is inserted into your rectum. The probe is a solid rod with an ultrasound device at the end. It creates pictures of your prostate and the surrounding area. If your doctor thinks that you may have cancer, a small sample of tissue may also be taken during the scan. Your doctor will then look at this tissue under a microscope to see if it contains any cancer cells.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.