1. Foundation
- Mediterranean-style diet: vegetables, legumes, whole grains, fish, olive oil
- Weight, blood pressure, glucose, and lipid optimization
- Regular aerobic + resistance exercise
- Manage evening fluids, alcohol, and caffeine for nocturia
2. Behavioral levers for LUTS
- Double voiding; avoid holding urine
- Timed voiding for urgency/frequency
- Review OTC decongestants and antihistamines that worsen symptoms
3. Supplement context
- Saw palmetto (standardized 320 mg/day) — heterogeneous evidence; some men benefit
- Pumpkin seed extract — modest LUTS improvement in trials
- Beta-sitosterol — flow and LUTS support in some studies
- Lycopene — long-term prostate wellness context
- Vitamin D — correct deficiency
4. When to add medical therapy
Bothersome LUTS, retention, recurrent UTI/hematuria from BPH, or renal impact warrant an alpha-blocker ± 5-alpha-reductase inhibitor and, in some cases, minimally invasive or surgical options. Screening decisions belong in a shared-decision conversation.