The doctor now knows what symptoms you have, how troublesome they are, what your prostate is like on examination and how fit you are. He or she will usually have a good idea what the problem is, but will want tests carried out to confirm this and to help plan your treatment. Some tests are done in nearly all cases, others only in certain situations.
You will be asked for a sample of your urine – this might be collected when the flow test is done. A blood sample is usually taken to check how your kidneys are working and to measure a substance called prostate-specific antigen (PSA). PSA is so important. The blood test results usually take a few days to come through.
Urine Flow Measurement
If the prostate obstructs the bladder opening, it will slow down the passage of urine. Machines that measure the flow of urine are used to test this. The test is very simple – you pass urine into a funnel-shaped container, just as if you were using a toilet, and all the measurements are done automatically.
However, the test is only accurate if a fairly large amount of urine is passed. It is a good idea to drink plenty of fluid before you go to the hospital and, if you can attend with your bladder comfortably full, so much the better. Do not worry if you haven’t been able to do this – you will be given some water to drink and allowed to wait until your bladder has filled before doing the test. If while you are in the waiting room you feel you need to pass urine, tell one of the clinic staff. You may be able to do the flow test straight away.
Sometimes when you first do the test you might pass only a little urine. If this happens and then a few minutes later you suddenly feel the urge to go again, do not go to the toilet, but tell one of the staff so you can use the flow machine again! When you are passing urine into the machine, relax – straining will affect the reading. Try and keep the stream in one direction; letting it ‘wander’ around the side may cause a false reading. You should also avoid knocking against the machine while using it. These precautions will help to produce a good record to show if the prostate is causing obstruction or not.
X-rays and Ultrasound
Men with prostate disease used to have an X-ray called an intravenous urogram (IVU), which involved an injection of a dye so that the kidneys show up on X-ray. Now, an IVU is done only in certain circumstances – for example, if blood has been seen in your urine.
A simple X-ray of your abdomen can be useful and is particularly good at making sure that there isn’t a stone in your bladder or kidneys. It also shows the size of the bladder, and so is usually done after passing urine – perhaps immediately after the flow test – to check how completely the bladder is emptying.
An ultrasound scan is used to look at the kidneys, and is very easy – a doctor or radiographer simply runs a small probe over the back and the front of your abdomen. Ultrasound can also be used to measure how well your bladder is emptying. This can be done at the same time as the kidneys are scanned, but there are also small portable machines designed just for this purpose and one of these might be used either by a doctor or a nurse in the clinic.