This patient with mild lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) should be conservatively managed with observation. The main purpose of treating LUTS from presumed BPH is to reduce bothersome symptoms. The American Urological Association Symptom Index (AUA-SI) score is a validated questionnaire used to determine the severity of and to monitor LUTS. The questionnaire assesses frequency, nocturia, weak stream, hesitancy, intermittency, incomplete emptying, and urgency, with each question graded on a 5-point scale from 0 (not present) to 5 (almost always present). The total score is interpreted as follows: 1-7 (mild), 8-19 (moderate), and 20-35 (severe). This patient's AUA-SI score of 4 indicates mild symptoms. The AUA currently suggests a treatment approach that is based on AUA-SI score severity. Mild LUTS from BPH can be addressed by observation. Conservative measures that may help patients with mild symptoms include reducing fluid intake, timed voiding (every 3 hours while awake), limiting caffeine and alcohol, modifying medications, improving mobility, and avoiding bladder irritants.

Urinalysis is the only test indicated for all patients with LUTS that is believed to be secondary to BPH. However, this patient's urinalysis, which shows only 2 leukocytes/hpf, does not clearly indicate the presence of a urinary tract infection, and his clinical presentation is not suggestive of chronic prostatitis. Therefore, antibiotic therapy with ciprofloxacin is not indicated.

5-α Reductase inhibitors, such as finasteride, are indicated in patients with large prostates (40 mL), elevated prostate-specific antigen levels, and/or severe symptoms of BPH. Finasteride is not indicated in this patient with mild symptoms.

α-Blockers, such as tamsulosin, are first-line therapy for treating BPH. However, observation without medical therapy would be the most appropriate first-line approach in this patient with mild BPH.