Clinical recommendation	Evidence rating	References
Men with suspected BPH can be evaluated with a validated questionnaire to quantify symptom severity.	C	6
In men with symptoms of BPH, a digital rectal examination and urinalysis should be performed to screen for other urologic disorders.	C	6
Watchful waiting with annual follow-up is appropriate for men with mild BPH.	C	6, 10
Alpha blockers provide symptomatic relief of moderate to severe BPH symptoms.	A	7, 12
In men with a prostate volume greater than 40 mL, 5-alpha reductase inhibitors should be considered for the treatment of BPH.	A	8, 14
Refer patients for a surgical consultation if medical therapy fails; the patient develops refractory urinary retention, persistent hematuria, or bladder stones; or the patient chooses primary surgical therapy.	C	6, 31, 32