Management of Lower Urinary Tract Symptoms in Patients on Active Surveillance for Prostate Cancer.

PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) are highly prevalent among ageing men and frequently coexist with low- and favorable-intermediate-risk prostate cancer. As the adoption of active surveillance (AS) increases and surveillance duration lengthens, clinicians are increasingly required to manage bothersome LUTS without compromising oncologic monitoring or future definitive treatment options. This review synthesizes contemporary evidence regarding the epidemiology, evaluation, and management of LUTS in men undergoing AS. RECENT FINDINGS: Emerging data demonstrate that medical and surgical therapies for benign prostatic hyperplasia (BPH) can be safely implemented in carefully selected men on AS. Contemporary evidence clarifies the impact of BPH therapies on prostate-specific antigen (PSA) interpretation, multiparametric MRI performance, biopsy feasibility, and candidacy for subsequent definitive prostate cancer treatment. Accumulating studies suggest that appropriately selected interventions aimed at improving bladder outlet obstruction do not adversely affect oncologic outcomes or compromise surveillance protocols. Management of LUTS in men undergoing AS requires a nuanced understanding of how BPH therapies interact with cancer surveillance strategies. Current evidence supports timely and individualized treatment of bothersome LUTS, including surgical management when indicated, without deferring intervention solely due to AS status. Thoughtful integration of symptom control and oncologic monitoring optimizes both quality of life and long-term cancer care.