BPH and prostate cancer are not interchangeable explanations for urinary symptoms. BPH most often produces bladder-outlet obstruction, whereas infection, stones, malignancy, medication effects, neurological disease, and an underactive bladder can produce overlapping complaints. Symptoms are commonly divided into: - Voiding symptoms: hesitancy, weak or intermittent stream, straining, and incomplete emptying. - Storage symptoms: urgency, frequency, and nocturia. For a symptomatic man, the initial assessment includes a history, physical examination with digital rectal examination, and urinalysis. Ask how symptoms affect sleep, work, and daily activities rather than relying only on the patient’s description of a “weak stream.” The International Prostate Symptom Score (IPSS) quantifies symptom burden and supports shared treatment decisions. A post-void residual may be useful when incomplete emptying or retention is suspected. PSA requires a careful distinction. The Canadian Task Force on Preventive Health Care recommends against PSA screening in asymptomatic men of all ages, including men aged 55–69, because overdiagnosis, unnecessary biopsy, infection, erectile dysfunction, and incontinence can outweigh a very small absolute mortality benefit. The Canadian Urological Association’s BPH guidance addresses a different question: in a symptomatic...