Aim of our study was to evaluate the association between prostatic calcification, evaluated by transrectal ultrasound, and LUTS in patients with benign prostatic enlargement (BPE).

From 2009 onward, a consecutive series of patients with LUTS-BPE were enrolled. Patients were evaluated using the International Prostate Symptom Score (IPSS) and transrectal ultrasonographic prostate volume. Body mass index, waist circumference and blood pressure were measured. Blood samples were collected for prostate-specific antigen levels. Prostatic calcifications were evaluated by transrectal ultrasound. Number of significative calcifications was defined≥ 4. Storage (sIPSS≥ 4) and nocturia ≥ 2 were considered significant. The risk of detecting significant storage symptoms and nocturia were evaluated using the logistic regression analysis.

201 patients were enrolled in two centers (Rome, Acquaviva delle Fonti, Italy) with a median age of 68 years (IQR 64/76) and PSA of 5 ng/ml (IQR 5/7). Median waist circumference was 94 cm (IQR: 89/102) and median IPSS was 10 (IQR 5/15). Overall 71/201 (35%) presented nocturia ≥2 and 75/201 (37%) presented sIPSS≥4. Overall 90/201 (45%) presented prostatic calcification and out of them 44/90 (49%) presented at least 4 calcifications. Patients with significant prostatic calcifications (at least 4) presented a significant higher sIPSS (5, IQR 3/10 vs 4, IQR 2/6; p= 0.018) and nocturia episodes (2, IQR 2/4 vs 1, IQR 1/2 vs, p= 0.001).

On multivariate analysis, prostatic calcifications were independent risk factors for storage LUTS (OR=2.87; CI: 1,36-6.05; p=0.012) and nocturia (OR: 2.7; CI: 1.24-3.2, p=0.005).

In our study prostatic calcifications, assessed using transrectal ultrasonography, are associated with an increased risk of storage LUTS and nocturia.  Although these results should be confirmed, and the pathophysiology is yet to be completely understood, assessment of prostatic calcifications is suggested in the evaluation of patients with LUTS and may reflect the presence of prostatic inflammation which is considered as a proxy of prostatic calcification.