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Background: Chronic prostatic inflammation has a key role in the pathogenesis and progression of benign prostatic hyperplasia (BPH). Thus, the identification of patients with chronic inflammation is mandatory for Urologists. This study investigates which clinical, imaging and laboratory findings are used by Urologists in clinical practice to diagnose BPH and chronic prostate inflammation., Methods: This was a multicenter, non-interventional, observational study involving 30 Italian large-volume primary care urology centers. Patients were allocated into four diagnosis group: patients with BPH; patients with BPH and chronic prostate inflammation; patients with chronic prostate inflammation alone; and patients with lower urinary tract symptoms (LUTS) due to other causes., Results: In total, 6134 patients were enrolled. BPH diagnosis with or without concomitant prostate inflammation was more frequent in older patients, while inflammation alone was prevalent in younger patients. Predictive factors for diagnosis of inflammation in all patients, regardless of age, were normal urinary flow (OR=2.73) and proved in-fection (OR=5.90), while in older patients (>61 years) diagnosis of chronic prostatic inflammation was specifically predicted by higher PSA values (≥4 ng/mL; OR=2.91), normal prostate volume (OR=10.23), mild symptoms (IPSS <8; OR=1.84), presence of intraprostatic calcifications (OR=4.55), and the combination of both infection and calcifications (OR=10.79)., Conclusions: In daily practice, the presence of chronic prostatic inflammation is underestimated. A stricter application of established diagnostic criteria suggested would increase the detection rate of chronic prostatic inflammation and potentially change the therapeutic approach in many patients with LUTS.