Digital rectal examination, serum prostatic specific antigen or transrectal ultrasonography: the best tool to guide the treatment of men with benign prostatic hyperplasia

Purpose of review Benign prostatic hyperplasia can be considered a progressive disease, and identifying men with progressive disease could have a significant impact on the decision to choose the different therapeutic options. Numerous pieces of evidence demonstrate the impact of the prostate volume on the disease progression. It has been accepted that digital rectal examination, serum prostatic specific antigen and transrectal prostate ultrasound are the available tools for the prostate volume estimation. This review examines the updated information on these tools for their guidance in the benign prostatic hyperplasia management. Recent findings Digital rectal examination is unreliable in assessing the prostate volume; however, it is still important to use it to rule out prostate cancer or neurological problems. Prostatic specific antigens should be recommended as a part of patient evaluation because of their impact on the prediction of disease progression. Transrectal prostate ultrasound may be the best tool in the estimation of the exact prostate size. Summary Numerous pieces of evidence have clearly demonstrated the impact of the prostate volume on the disease progression. Digital rectal examination seems to be good at identifying very large prostate. Prostatic specific antigen is the best tool for predicting disease progression and guiding the therapeutic options. For surgical guidance, transrectal prostate ultrasound is the useful tool available for the exact prostate volume estimation.