5th May 2024

A 68-year-old man presents with a 6-month history of increased frequency of urination, nocturia, and a decreased urinary stream.

A 68-year-old man presents with a 6-month history of increased frequency of urination, nocturia, and a decreased urinary stream. He has no history of urinary tract infections or hematuria. He has a known history of benign prostatic hyperplasia (BPH) and is currently not on any medication for it. His medical history includes controlled hypertension. Digital rectal examination reveals an enlarged, smooth, non-tender prostate. His prostate-specific antigen (PSA) level is 2.5 ng/mL. He expresses that his symptoms are affecting his quality of life.

Which is the most appropriate initial management?