Behavioral/lifestyle interventions are attractive first-line therapies for many men with LUTS/BPH due to their wide accessibility, personalization, and low risk of harm. Many lifestyle interventions, such as weight loss and structured exercise, also have well-established mental and physical health benefits beyond LUTS/BPH, which may further motivate adherence to long-term behavioral changes. The Panel reviewed four RCTs that evaluated behavioral and/or lifestyle interventions for LUTS/BPH.132-135 Targeted mechanisms of action were highly heterogeneous and there was minimal overlap in interventions tested across studies, including weight loss, general exercise, supervised pelvic floor muscle training, and other self-management techniques. All four trials demonstrated a modestly greater improvement in IPSS and quality of life in the intervention group compared to the active control group. The between-group difference in both IPSS and quality of life was statistically significant in three out of four trials. Adverse events were minimal and not higher in the intervention group, although they were inconsistently reported. Although comparative effectiveness trials with an active drug comparator group were not included in this Guideline’s systematic review, the mean effect size of behavioral and/or lifestyle interventions and pharmacologic BPH therapies are of similar magnitude. A systematic review and meta-analysis of three trials directly comparing LUTS self-management versus drug therapy found no evidence of a difference in symptom severity at 6-12 weeks, particularly in the setting of concurrent BPH and OAB.136 In particular, men with BPH who are most bothered by nocturia may be more responsive to behavioral and/or lifestyle interventions compared to AB monotherapy.137 Another large cluster RCT among 1,077 men with LUTS (i.e., not necessarily due to BPH) demonstrated that a 12-month standardized self-management advice booklet was superior to usual care as determined by clinicians in the control group.138 Lastly, given the disproportionately high prevalence of obesity, diabetes, cardiovascular disease, and vasculogenic ED among men with BPH, general lifestyle interventions such as smoking cessation, maintaining a healthy weight, and regular exercise would benefit all men with BPH and some may be particularly motivated by the possibility of modest improvements in LUTS.139 The Panel developed Table 3 based on expert opinion for recommended lifestyle modifications for patients with LUTS/BPH.   <img src="images/Guidelines/Guideline%20Images/2026%20BPH/BPH%20Table%203.png" alt="Table 3" title="Table 3" width="700" height="515" class="blockImg" />