Watchful waiting is recommended for patients with benign prostatic hyperplasia (BPH) whose clinical symptoms do not affect their quality of life. Use a validated patient questionnaire, such as the American Urological Association's Symptom Index, to establish the severity of BPH symptoms and follow their progression. alpha-Adrenergic blockers (either selective or nonselective) or 5-alpha reductase inhibitors are appropriate first-line therapies for patients bothered by BPH symptoms. Consider surgery for patients with severe obstructive symptoms who have not benefited from medical therapy or who prefer surgery as first-line treatment.