When the range of treatment options for benign prostatic hyperplasia (BPH) is as broad as the BPH spectrum of symptoms, how should urologists and their patients choose the best initial treatment? Treatment goals should include reducing both lower urinary tract symptoms and relieving associated morbidities, such as urinary retention, persistent gross hematuria, recurrent infections, bladder stones, or renal insufficiency-which are all indications for surgery. However, if one views BPH as a chronic and progressive disease, should a primary goal of BPH management be the prevention of the BPH-associated morbidities? The goal of this paper is to provide a literature update regarding various treatment options in the setting of initial treatment for symptomatic BPH. Novel approaches to BPH management are discussed. In all cases, the risks and benefits of each treatment need to be considered and discussed with the patient; the decision is ultimately up to the patient and his urologist.