A 62-year-old man visited our clinic after a routine health screening suggested possible benign prostatic hyperplasia (BPH). However, when reviewing the screening report more closely, we found that the prostate had been measured using a lower abdominal bladder ultrasound. This method can sometimes provide only a partial view of the prostate and may not accurately determine its true size.
To obtain a more reliable diagnosis, additional tests were performed. These included uroflowmetry with post-void residual urine measurement and a transrectal ultrasound examination. The results showed a maximum urinary flow rate of 16.9 mL/s and a prostate volume of 15.4 cc. Considering that a normal maximum flow rate is generally above 15 mL/s and the typical prostate size ranges from 15 to 20 cc, the findings were within the normal range. The patient also reported no urinary symptoms, so active treatment was not necessary. Instead, periodic monitoring was recommended, and the patient returned home.
This case illustrates an important point. Even if a health screening suggests possible benign prostatic hyperplasia, immediate treatment is not always required. In many cases, further evaluation is needed to confirm the diagnosis and determine whether intervention is actually necessary.
In recent years, more patients have been visiting urology clinics after being told during routine health screenings that BPH may be present. However, as mentioned earlier, most screening programs rely on lower abdominal ultrasound examinations, which have limitations in accurately measuring prostate size. As a result, some patients diagnosed with “suspected BPH” during screening may ultimately have normal prostate size and no significant urinary symptoms. In such cases, careful observation rather than immediate treatment may be recommended.
When a patient visits a urology clinic with suspected BPH, the evaluation usually begins with a detailed medical history and symptom assessment. Physicians review past medical conditions and current medications while evaluating the severity of lower urinary tract symptoms. To obtain an objective assessment, the International Prostate Symptom Score (IPSS)—a globally standardized questionnaire—is commonly used.
Next, a transrectal prostate ultrasound is performed to accurately measure the size and structure of the prostate. Uroflowmetry and post-void residual urine testing are also conducted to measure the maximum urinary flow rate and the amount of urine remaining in the bladder after urination. These tests help determine the degree of urinary obstruction.
If abnormalities are detected in these basic tests, further evaluation may be performed using cystoscopy. This procedure allows direct visualization of the urethra, prostate, and bladder to assess structural problems more precisely.
Many patients become concerned that surgery may be required when they are told that BPH is suspected during a health screening. However, surgical treatment for benign prostatic hyperplasia is recommended only when it is truly necessary. At our clinic, decisions regarding surgery are made after evaluating five key clinical areas.
First, the size, location, and structural characteristics of the enlarged prostate tissue are assessed. Second, the severity of lower urinary tract symptoms experienced by the patient is evaluated. Third, physicians consider whether prostate enlargement is affecting bladder or kidney function. Fourth, possible complications such as hematuria, hydronephrosis, bladder stones, or recurrent urinary tract infections are assessed. Finally, the timing of symptom onset, the duration of medication treatment, and any previous treatments are reviewed.
According to data from the Health Insurance Review and Assessment Service (HIRA) in Korea, the number of patients diagnosed with benign prostatic hyperplasia increased from 1,191,595 in 2017 to 1,426,279 in 2022, representing a 19.7% increase over five years. This trend reflects the rapid growth of the aging population.
Benign prostatic hyperplasia can significantly affect quality of life in middle-aged and older men. In severe cases, it may lead to complications such as acute urinary retention, bladder dysfunction, hematuria, or hydronephrosis. For this reason, if BPH is suspected during a health screening, visiting a urology clinic for a comprehensive evaluation is recommended. Accurate diagnosis and timely management can help prevent complications and maintain urinary health.
As men age, various urologic conditions may begin to interfere with daily life. Providing objective and practical information about urologic health can help individuals maintain a healthier and more comfortable life during middle age and beyond.