User • 2026. 03. 11.
My father has been urinating frequently at night and his urine stream has become weaker. For his upcoming check-up, what tests should be included to accurately evaluate his prostate condition?
Is the prostate-specific antigen (PSA) blood test alone sufficient to clearly distinguish between prostate cancer and benign prostatic hyperplasia (BPH)?
To assess the size and shape of the prostate more precisely, is a transrectal prostate ultrasound (TRUS) essential?
Would a uroflowmetry or urodynamic test, which measures urine flow rate and post-void residual volume, be helpful in determining the severity of his current symptoms?
Before starting medication for BPH, would it also be advisable to check bladder function and kidney function?
Ryu Kyung-ho
Goldman UrologyDirector, Goldman Urology Gangnam
Hello, this is Dr. Kyungho Ryu from Goldman Urology Clinic, Gangnam.
Frequent nighttime urination and a weakened urine stream in men in their late 60s may be early signs of benign prostatic hyperplasia (BPH).
The prostate-specific antigen (PSA) blood test is a basic marker used to assess the risk of prostate cancer. However, PSA alone cannot clearly distinguish between prostate cancer and BPH. Since BPH involves enlargement of prostate tissue that compresses the urethra, it is important to evaluate the size and shape of the prostate through ultrasound.
A transrectal ultrasound (TRUS) is an effective way to assess the internal condition of the prostate. In addition, uroflowmetry and post-void residual measurement help evaluate urine flow rate and how much urine remains in the bladder, which are useful for determining the severity of urinary symptoms.
Before starting medication for BPH, it is also advisable to assess kidney function and bladder function to rule out potential complications.
Basic evaluation for BPH typically begins with medical history and urinalysis, followed by imaging and functional tests. These examinations are generally quick and non-invasive, so there is no need for excessive concern.
✅ What is BPH?
Benign prostatic hyperplasia is a common condition associated with aging, in which the prostate gradually enlarges and compresses the urethra, leading to various urinary symptoms.
Although it becomes more common after the age of 50, it can also occur in younger individuals due to factors such as diet, stress, and prolonged sitting habits.
✅ Common symptoms of BPH
✔ Weak urine stream
✔ Difficulty starting urination
✔ Intermittent urine flow
✔ Prolonged urination time
✔ Frequent urination
✔ Nocturia (waking up at night to urinate)
✔ Urgency (sudden need to urinate)
✔ Feeling of incomplete emptying
✅ Diagnostic tests for BPH
✔ Medical history and symptom scoring (IPSS)
Evaluates frequency, urgency, and nocturia based on standardized scoring.
✔ Digital rectal examination (DRE)
A physical exam to assess prostate size, firmness, and abnormalities.
✔ Uroflowmetry + post-void residual measurement
Assesses urine flow strength and remaining urine after voiding.
✔ Urinalysis and PSA blood test
Checks for infection and evaluates prostate cancer risk.
✅ Treatment options
Many patients can manage symptoms effectively with medication. However, if symptoms do not improve or complications occur—such as acute urinary retention, recurrent infections, bladder stones, or kidney dysfunction—surgical treatment may be considered.
There are various treatment options depending on the patient’s condition:
✔ HoLEP (Holmium Laser Enucleation of the Prostate)
Removes enlarged prostate tissue completely with minimal bleeding and low recurrence rate.
✔ UroLift
A minimally invasive procedure that lifts and holds prostate tissue to relieve urethral compression without cutting or removing tissue.
✔ Waterjet robotic surgery (Aquablation)
Uses high-pressure water jets for precise, heat-free tissue removal.
✔ Plasma TURis
Removes tissue using low-temperature plasma energy.
✔ Rezum therapy
Uses steam to reduce prostate tissue; suitable for older patients or those with comorbidities.
✔ iTind procedure
A temporary implant expands the urethra and is removed after several days, maintaining improved urine flow.
✅ Treatment cost considerations
The cost of BPH treatment varies depending on the procedure, hospitalization, and insurance coverage. Common procedures such as HoLEP, Aquablation, and Rezum differ significantly in cost.
Rather than comparing cost alone, it is more important to determine which treatment is most appropriate based on prostate size, symptoms, and overall health condition.
As the prostate continues to enlarge with age, symptoms of BPH may gradually worsen. If left untreated, it can lead to complications such as urinary tract infections, cystitis, pyelonephritis, bladder stones, and bladder dysfunction.
At our clinic, we carefully assess each patient’s condition based on extensive clinical experience and provide accurate diagnosis and personalized treatment plans.
Identifying the exact cause is the first step toward effective treatment.
If you have persistent symptoms suggestive of BPH, we recommend visiting a urology clinic for evaluation.
Thank you, and we hope this information was helpful.
* This answer is based on medical documents and cannot replace an actual diagnosis.