Prostate Concretions (Prostatic Calculi): Causes, Symptoms & Management

Prostatic calculi are tiny calcium phosphate stones within prostatic ducts/acini. Usually asymptomatic, incidental on imaging.

When Symptomatic

• Perineal/suprapubic pain, dysuria, frequency, hematospermia.
• Association with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
• May obstruct ducts → recurrent infection.

Management

• Asymptomatic: No treatment needed; monitor.
• Symptomatic:
  • α-blockers (tamsulosin) ± 5-ARI (finasteride) for voiding symptoms.
  • Antibiotics if chronic bacterial prostatitis documented (4–6 weeks).
  • Transurethral resection of prostate (TURP) or laser if large stones causing obstruction/refractory symptoms.

Prevention (Unproven but Reasonable)

• Adequate hydration.
• Limit caffeine/alcohol (bladder irritants).
• Regular ejaculation may reduce stasis.
• Treat BPH/prostatitis promptly.

Most men with prostatic calculi never know they have them. Intervention only if symptomatic.