Benign prostatic hyperplasia (BPH) is a highly prevalent, age-related condition characterized by nonmalignant enlargement of the prostate that leads to lower urinary tract symptoms (LUTS) in men. Management has evolved toward a patient-centered, evidence-based approach that balances symptom severity, prostate size, comorbidities, and patient preferences. Initial evaluation includes a focused history, symptom assessment using validated tools such as the International Prostate Symptom Score, digital rectal examination, urinalysis, and selective use of prostate-specific antigen testing to estimate prostate volume and progression risk.

First-line therapy for mild symptoms often involves behavioral and lifestyle modifications, including fluid management, reduction of caffeine and alcohol intake, and treatment of contributing conditions such as constipation or sleep apnea. For men with persistent or moderate-to-severe symptoms, medical therapy is the cornerstone of treatment. Alpha-adrenergic blockers provide rapid symptom relief by reducing smooth muscle tone in the prostate and bladder neck. Five-alpha reductase inhibitors are used in men with enlarged prostates to reduce gland size, lower the risk of urinary retention, and decrease the need for surgery. Combination therapy is commonly employed in patients with significant symptoms and larger prostate volumes.

Minimally invasive surgical therapies have expanded treatment options for patients who fail or cannot tolerate medications. Techniques such as prostatic urethral lift, water vapor thermal therapy, and temporary implantable devices offer symptom improvement with reduced impact on sexual function and shorter recovery times. For more severe obstruction or larger prostates, established surgical approaches including transurethral resection of the prostate and laser-based enucleation provide durable symptom relief with high efficacy.

Contemporary BPH management emphasizes shared decision-making, with careful discussion of risks, benefits, and functional outcomes. Regular follow-up is essential to monitor symptom progression, treatment response, and potential complications. This individualized approach allows us to optimize quality of life while minimizing treatment burden for men with prostate enlargement.