Watchful Waiting with Follow-Up if Symptoms Change

Rationale for Conservative Management

The American Urological Association guidelines recommend that patients with non-bothersome lower urinary tract symptoms (LUTS) and non-suspicious prostate enlargement do not require further evaluation if symptoms are not significantly bothersome or the patient does not want treatment, and should be reassured and followed up if necessary 1
Patients with non-bothersome LUTS are unlikely to experience significant health problems in the future due to their condition, supporting a conservative management approach 1

The American Urological Association specifies that biopsy is only indicated when digital rectal exam (DRE) is suspicious for prostate cancer or PSA is elevated, which is not the case in this patient 2
Medical therapy with alpha-blockers is reserved for patients with bothersome symptoms, and this patient is described as unbothered by his symptoms 1, 3
Antibiotics are only indicated when urinalysis or culture demonstrates infection, which is not present in this case 1, 5

Annual follow-up is recommended for patients choosing watchful waiting, with repeat evaluation to detect changes in symptoms or development of complications 3
Follow-up visits should include assessment of symptom severity and bother using a standardized tool if symptoms worsen, and reassessment of the need for intervention 3, 4

Treatment decisions should be driven by symptom bother and impact on quality of life, not simply by the presence of mild urinary frequency or prostate enlargement, to avoid over-treating asymptomatic or minimally symptomatic patients 1, 3