Diagnostic Advances in Canine BPH: From Palpation to Precision Medicine

The diagnosis of benign prostatic hyperplasia (BPH) in dogs has progressed significantly with the integration of advanced diagnostic tools alongside traditional clinical methods. While many cases remain subclinical, the increasing awareness among pet owners and improved access to diagnostic modalities have made early detection more feasible in veterinary practice^1,2. Given the nonspecific nature of clinical signs and overlap with other prostatic disorders, a structured and multimodal diagnostic approach is essential. 

Clinical Examination and Digital Rectal Palpation 

The diagnostic process typically begins with a detailed clinical history and physical examination. Digital rectal examination (DRE) remains a simple, cost-effective, and practical screening tool that can be performed during routine evaluations³. In dogs with BPH, the prostate is generally symmetrically enlarged, nonpainful, and maintains a normal consistency and mobility⁴. However, its diagnostic accuracy is limited in cases where the prostate is located cranially or remains within the pelvic canal, making it difficult to palpate^1. 

Despite these limitations, DRE provides valuable preliminary information and can guide further diagnostic investigations. Studies have demonstrated its usefulness as a screening tool, with a relatively high specificity and predictive value in identifying subclinical prostatic disorders¹. 

Ultrasonography: First-Line Imaging Tool 

Ultrasound remains the most widely utilized imaging modality for evaluating prostatic disorders in dogs. It allows for assessment of the prostate’s size, shape, echogenicity, and internal architecture⁵. In cases of BPH, ultrasonographic findings typically reveal symmetrical enlargement, heterogeneous parenchyma, and the presence of diffuse cystic patterns or small intraprostatic cysts^1,6. 

Comparative studies have consistently shown that dogs affected by BPH exhibit increased prostate dimensions and altered tissue characteristics compared to healthy dogs³. However, ultrasonography is not disease-specific, and similar imaging features may be observed in prostatitis, cysts, abscesses, or neoplasia, necessitating further diagnostic confirmation¹. 

Advanced Imaging: CT and Functional Techniques 

Computed tomography (CT) has emerged as a valuable diagnostic tool for detailed evaluation of the prostate and surrounding pelvic structures. It provides accurate measurements of prostatic dimensions and enables assessment of parenchymal characteristics and perfusion parameters. Studies have demonstrated that prostates affected by BPH are significantly larger and show distinct structural changes compared to normal glands^7,8. 

Despite its advantages, CT is not routinely used due to its higher cost, limited availability, and requirement for general anesthesia. Therefore, it is generally reserved for complex or inconclusive cases where ultrasonographic findings are insufficient¹. 

Functional imaging techniques such as Doppler ultrasonography and elastography are gaining attention for their ability to provide additional diagnostic insights. Doppler evaluation has shown increased blood flow velocity in the prostatic artery in dogs with BPH, reflecting vascular changes associated with hyperplasia. Elastography, on the other hand, assesses tissue stiffness and has demonstrated high specificity in distinguishing normal from pathological prostates, although its sensitivity remains moderate¹. 

Cytology and Histopathology 

Cytological evaluation plays an important role in confirming the diagnosis and differentiating BPH from other prostatic conditions. Techniques such as fine needle aspiration (FNA), prostatic wash, and ejaculation-based sample collection are commonly used¹. Among these, ultrasonography-guided FNA is considered a quick and minimally invasive method. 

Studies have reported a high level of concordance between cytological findings and histopathological results, supporting its diagnostic reliability. FNA cytology is particularly useful in cases where clinical and imaging findings are inconclusive or when neoplasia is suspected¹. 

CPSE: A Key Serum Biomarker 

Canine prostate-specific esterase (CPSE) has emerged as a valuable biomarker in the diagnosis and monitoring of prostatic disorders. Elevated serum CPSE levels have been consistently associated with BPH, prostatitis, and other prostatic conditions. Its clinical applications include early screening, diagnostic support, and monitoring response to treatment¹. 

Studies have demonstrated significantly higher CPSE levels in dogs with BPH compared to healthy individuals, making it a useful tool for identifying subclinical cases. Moreover, combining CPSE measurement with ultrasonographic evaluation enhances diagnostic accuracy and reduces reliance on more invasive or expensive diagnostic procedures¹. 

Emerging Biomarkers and Future Directions 

Recent research has explored the potential role of novel biomarkers such as microRNA (miRNA) and vascular endothelial growth factor (VEGF) in the diagnosis of canine BPH. Alterations in miRNA expression and increased VEGF levels have been associated with prostatic enlargement and disease progression¹. Although these markers show promise, their clinical application requires further validation. 

Conclusion 

The diagnosis of canine BPH has evolved into a comprehensive process that integrates clinical examination, imaging, cytology, and biomarker analysis. While traditional methods such as DRE and ultrasonography remain fundamental, the incorporation of CPSE and advanced imaging techniques has significantly improved diagnostic precision. A multimodal approach is essential to accurately differentiate BPH from other prostatic disorders and to ensure appropriate clinical management. 

References: 

1. Derakhshandeh N, Mogheiseh A, Nazifi S. Diagnosis and Treatment of Benign Prostatic Hyperplasia in Dogs: New Approaches. Veterinary medicine international. 2025;2025(1):4153172. https://onlinelibrary.wiley.com/doi/pdf/10.1155/vmi/4153172 

2. M. Melandri and S. Alonge, “Highlights on the Canine Prostatic Specifc Esterase (CPSE): A Diagnostic and Screening Tool in Veterinary Andrology,” Veterinary Medicine and Science 7, no. 1 (2021). https://onlinelibrary.wiley.com/doi/pdf/10.1002/vms3.349 

3. T. Laurusevicius, J. ˇ Siug ˇ zdait ˇ e, N. Juod ˙ ziukynien ˇ e, et al., ˙ “Comparative Evaluation of Diagnostic Methods for Subclinical Benign Prostatic Hyperplasia in Intact Breeding Male Dogs,” Animals 14, no. 8 (2024). https://www.mdpi.com/2076-2615/14/8/1204 

4. M. R. Das, R. C. Patra, R. K. Das, P. K. Rath, and B. P. Mishra, “Hemato-Biochemical Alterations and Urinalysis in Dogs Sufering From Benign Prostatic Hyperplasia,” Veterinary World 10, no. 3 (2017): 331–335. https://pmc.ncbi.nlm.nih.gov/articles/PMC5387661/pdf/VetWorld-10-331.pdf 

5. A. Adel and M. khadidja, “Canine Prostatic Disorders,” Open Veterinary Journal 2, no. 3 (2017): 83–90. https://openventio.us/index.php/VM/article/download/637/571 

6. W. Niza˙ nski, M. Ochota, C. Fontaine, and J. Pasikowska, “B- ´ Mode and Doppler Ultrasonographic Findings of Prostate Gland and Testes in Dogs Receiving Deslorelin Acetate or Osaterone Acetate,” Animals 10, no. 12 (2020): 2379. https://www.mdpi.com/2076-2615/10/12/2379 

7. Y. Vali, S. Soroori, M. Molazem, et al., “Comparison of Computed Tomographic and Cytological Results in Evaluation of Normal Prostate, Prostatitis and Benign Prostatic Hyperplasia in Dogs,” Veterinary Research Forum: An International Quarterly Journal 10, no. 1 (2019): 17–22. https://pmc.ncbi.nlm.nih.gov/articles/PMC6522197/pdf/nihpp-rs4169007v1.pdf 
8. T. Laurusevicius, S. Kerzien ˇ e, N. Juod ˙ ziukynien ˇ e, et al., ˙ “Evaluation of Healthy and Subclinical Benign Prostatic Hyperplasia Afected Intact Male Dogs Using Ultrasonography and Specifc Features of Computed Tomography,” Pakistan Veterinary Journal 43, no. 4 (2023). http://pvj.com.pk/pdf-files/23-220.pdf